.x^' 



A TEXT-BOOK 



MATERIA MEDICA, 



THERAPEUTICS, AND PHARMACOLOGY. 



BY 

GEORGE FRANK BUTLER, Ph.G, M.D., 

Professor of Materia Medica and Clinical Medicine in the College of Physicians and Surgeons, 

Medical Department of the University of Illinois ; Professor of General Medicine and Diseases 

of the Digestive System, Chicago Clinical School ; Attending Physician to Cook County 

Hospital; Member of the American Medical Association, Illinois State Medical Society, 

Chicago Medical Society, Chicago Pathological Society, and Chicago Society of 

Internal Medicine ; Fellow of the Chicago Academy of Medicine, etc. 



SECOND EDITION, REVISED. 



Miseris succtirrere disco. 



PHILADELPHIA : 

W. B. SAUNDERS, 

925 Walnut Street. 
1898. 



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13951 



Copyright, 1898, 
By W. B. SAUNDERS 




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ELECTROTYPED BY 
WESTCOTT & THOMSON, PHILAOA. 



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PRESS OF 
W. B. SAUNDERS, PHILADA. 



TO 



THE MEDICAL STUDENTS OF THE UNITED STATES, 

IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT 

KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS 

AND THE RATIONAL TREATMENT OF DISEASE, 

THIS WORK IS CORDIALLY INSCRIBED BY 

THE AUTHOR. 



PREFACE TO THE SECOND EDITION. 



It is peculiarly gratifying to the author to be so soon called 
upon to revise his book on Materia Medica, Therapeutics, and 
Pharmacology for the second edition, since it is an evidence of 
the very favorable reception and appreciation of the work by 
medical teachers, students, and physicians generally. 

Since the pubhcation of the first edition there have been many 
advances in pharmacology, rather in the direction of clearing from 
obscurity the action of old remedies than in marvellous new dis- 
coveries. In this respect therapeutics has but followed the normal 
line of the evolution of science. 

The recent important additions made to the knowledge of the 
physiological action of drugs principally relate to antipyretics, 
antiseptics, aconite, and strychnine. These, as well as some minor 
changes in the pharmacology of a few other drugs, appear in the 
present edition. Many alterations also have been made in the 
chapters on diuretics and cathartics. 

One of the principal innovations is the substitution of a chapter 
on the Untoward Effects of Drugs for that on Definitions. The 
tables given summarize all contributions to the subject to date. 

Serum-therapy and the therapeutics of nuclein have received 
considerable attention during the past year, and these interesting 
topics are more fully discussed in the present issue. 

The author earnestly requests any reader who may discover an 
error of whatsoever nature in this edition to report the same to 
him promptly, and hopes that the work as revised will continue to 
prove of value to the medical profession. 

GEORGE FRANK BUTLER. 

794 West Adams St., Chicago, 
August, 1898. 



PREFACE 



The present work has been undertaken with the immediate 
object of supplying the student of medicine with a clear, concise, 
and practical text-book, adapted for permanent reference no less 
than for the requirements of the class-room. 

The arrangement — embodying the synthetic classification of 
drugs based upon therapeutic affinities — the author believes to be 
at once the most philosophical and rational, as well as that best 
calculated to engage the interest of those to whom the academic 
study of the subject is wont to offer no little perplexity. 

Should an intelligent and comprehensive understanding of 
Materia Medica and Therapeutics be facilitated by the author's 
treatment of the theme, the deductions derived from his experience 
as a practitioner and instructor will not have been committed to 
print in vain. 

Special attention has been given to the Pharmaceutical section, 
which there is reason to hope will be found exceptionally lucid 
and complete. It has been deemed advisable, however, in the 
general work to include in the descriptive enumeration only such 
drugs as experience has proved to be of unquestionable value 
and are of standard and authoritative acceptance in general prac- 
tice. In accordance with this plan, many new and comparatively 
untried remedies have been omitted, since, while of established 
efficacy in certain conditions, they are as yet too imperfectly known 
to warrant association with remedial agents bearing the sanction 
of exhaustive scrutiny. So, too, a few official drugs have been 
excluded because they are practically never used or are employed 
only in isolated instances. 

It will be observed that ''Untoward Action'' and ''Poisoning" 

11 



12 ; PREFACE. 

are treated under separate heads. By the former it is intended to 
record the effects of "inedicinal doses in developing certain symp- 
toms dependent more or less upon individual susceptibility, not 
necessarily assuming the aggravated form incident to toxic doses, 
which exert a definite influence regardless of idiosyncrasy. 

In giving the careful Latin accent and quantity of medicinal 
nomenclature (Foster), so far as practicable with the prosodial 
signs employed, the design has been to correct a prevalent dis- 
regard of proper pronunciation reflecting little credit upon those 
to whom a knowledge of the subject should be as exact as it is 
familiar. To the prescription-writer the appropriate Latin genitive, 
and in a few cases the accusative, will doubtless afford valuable 
assistance. 

During the preparation of the work many important text- 
books, periodicals, etc. have been freely consulted, and from the 
U. S. Pharmacopoeia chiefly, and from the National Dispensatory, 
have been adopted almost verbatim the ''Orighi'' and ''Description 
and Properties " of the various drugs under consideration. 

In reviewing the progress of the present volume the author 
desires to express his cordial acknowledgments to Prof Carl S. N. 
Hallberg, Ph. G., whose exhaustive contribution of "Weights and 
Measures" and ** Pharmaceutical Preparations" cannot fail to 
lend permanent interest to the work ; to Dr. Alfred C. Cotton, Dr. 
Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions ; 
to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jack- 
son, for assistance in compilation. To Mr. Storrow Higginson the 
author's personal thanks are due for his scholarly assistance in 

the revision of the text. 

G. F. B. 
Chicago, III,, 794 West Adams St., 
September, 1896. 



CONTENTS 



PAGE 

INTRODUCTION 17 

PHARMACOLOGY AND GENERAL THERAPEUTICS 21 

Classification of Medicines 24 

Administration of Medicines 29 

Untoward Effects of Drugs 34 

Weights and Measures 42 

PHARMACEUTICAL PREPARATIONS 51 

Solutions 52 

Aquae Medicatse — Medicated Waters 53 

Liquores — Solutions 53 

Spiritus — Spirits 59 

Syrupi — Syrups 60 

Elixiria — Elixirs 66 

Glycerita — Glycerites , 73 

Liquid Mixtures — Internal 74 

Misturae — Mixtures 74 

Emulsa — Emulsions 78 

Extractive Preparations , 81 

Infusa — Infusions , S;^ 

Decocta — Decoctions 84 

Aceta — Vinegars 84 

Vina — Wines 84 

Tincturae — Tinctures , 86 

Extracta Fluida — Fluid Extracts 92 

Extracta — Extracts 97 

Abstracta — Abstracts 98 

Oleoresinae — Oleoresins 99 

Resinae — Resins 100 

Solid Mixtures for Internal Use 101 

Pulveres — Powders 102 

Sales Effervescentes — Effervescent Salts 105 

Confectiones — Confections 106 

Trochisci — Troches 107 

Massae — Masses 108 

Pilulae— Pills 109 

Unofficial Forms of Mixtures of Solids for Internal Use 114 

Preparations for External Use ng 

Linimenta — Liniments Ii5 

Lotiones — Washes 117 

Oleata — Oleates jjg 

13 



14 CONTENTS, 

PAGE 

Olea Infusa — Infused Oils 119 

Collodia — Collodions 119 

Unguenta — Ointments 120 

Cerata — Cerates 122 

Suppositoria — Suppositories ' . . 123 

Emplastra — Plasters 124 

Chartae — Papers , 126 

Poultice or Cataplasm 127 

Fomentations 127 

Plaster Mull 127 

Bandages, Antiseptic Dressings 127 

Medicated Dressings 128 

Medicated Cottons 128 

Medicated Gauzes — Carbasa 128 

Plaster-of- Paris Bandages • 120 

CLASS L— DISEASE MEDICINES 131 

Division I. — Restoratives 131 

Group I. — Digestants 131 

Group II. — Fats and Oils 134 

Group III. — Mineral Acids . 137 

Group IV. — Vegetable Acids 148 

Group V. — Alkalies 151 

Group VI. — Mineral Waters 167 

Group VII. — Bitters 172 

Simple Bitters 172 

Aromatic Bitters . 174 

Group VIII. — Hematics 181 

Animal Extracts (Organo-therapy) 219 

Division II. — Alteratives 223 

Serum-therapy 271 

Division III. — Antiseptics 304 

Aromatics 359 

CLASS IL— SYMPTOM MEDICINES 381 

Group I. — Antispasmodics 3^1 

Group II. — Antipyretics 39c> 

Group III. — Anesthetics 39^ 

Group IV. — Hypnotics 412 

Group V. — Narcotics 429 

Group VI.— Motor Excitants 466 

Group VH.— Motor Depressants 500 

Bromides 529 

Group VIII.— Cardiac Stimulants 53^ 

Group IX.— Cardiac Sedatives 57^ 

Group X. — Diaphoretics 594 

Group XL— Emetics 6°^ 

Group XII.— Expectorants 616 

Group XIIL— Diuretics 63a 



CONTENTS. 15 

PAGE 

Group XIV. — Cathartics 658 

Laxatives 666 

Simple Purgatives 674 

Hydragogue Purgatives 684 

Salines 688 

Drastic Purgatives 691 

Group XV. — Anthelmintics 695 

Group XVI. — Emmenagogues and Ecbolics 704 

Group XVII. — Astringents 710 

Vegetable Astringents 712 

Mineral Astringents 726 

TOPICAL REMEDIES. 

Group XVIII. — Caustics or Escharotics 75^ 

Group XIX. — Vesicants and Epispastics l^Z 

Group XX. — Rubefacients ITi 

Group XXI. — Emollients, Demulcents, and Protective Agents . . . 773 

PRESCRIPTIONS 784 

INDEX 813 



A TEXT-BOOK 



OF 



MATERIA MEDICA, 

THERAPEUTICS, AND PHARMACOLOGY. 



INTRODUCTION. 



The history of medicine since the time of Hippocrates is the 
record of a more or less continuous series of experimental re- 
searches, having for their paramount object a precise and compre- 
hensive knowledge of the nature of disease and the practical 
application of remedial science. Regarded sensu latiori, the 
various " schools " which have arisen from time to time are 
philosophically co-ordinate, their fundamental principles being ref- 
erable to one dominating thought — the art of healing. 

It is scarcely practicable here, even were it necessary, to review 
in detail the ' separate doctrines which have obtained during the 
evolution of sectarian therapy. From the earliest ideas promul- 
gated by the ancient priests of yEsculapius, through the subse- 
quent era of Hippocrates, Theophrastus, and the Alexandrian 
school, influenced by the crude, misguided notions prevailing ere 
science emerged from its infancy ; discernible in the Galenic and 
other tentative yet memorable systems, in the epoch of Paracelsus 
and the Monastic Medicine of the Mediaeval period, and in the 
radical theories of Rasori and Roeschlaub which attended the 
development of the last, and have left a passing impress upon the 
present, century, — through all, the gradual acceptance of empiri- 
cism as a legitimate guide to therapeutic truth is manifest. Yet 
viewed with reference to their underlying animus, these varied 
expressions of scientific endeavor distinguishing the past are per- 
ceptibly linked with the ampler system which has emanated from 
the more rational methods of modern research. 

2 17 



l8 A TEXT-BOOK OF MATERIA MEDICA. 

The light of inductive reasoning and the marvellous progress in 
scientific knowledge which characterize the nineteenth century are 
a living appeal from the idealism of a less enlightened age. The 
release from tradition — anticipated in the labors of Bichat and 
others — to which later investigation owes so many signal triumphs 
has doubtless been profoundly affected by the realistic tendency of 
modern thought. It is to the startling advancement attained in the 
natural sciences, however, resulting in a chemical skill and in me- 
chanical appliances of incomparable value, that we must look for 
the originating impulse which has inspired the therapeutic know- 
ledge, of the present day. It needs but little reflection to perceive 
the immeasurable superiority of actual acquirements over the vague, 
hesitating — though ardent and laborious — methods to which the 
theory and practice of medicine were so long subservient. 

We have said that, considered in the larger sense, the history of 
medicine has been a harmonious rather than an intermittent devel- 
opment. It is not to be supposed that, in the evolution of so 
momentous a scheme as the formulation of a remedial system 
appHcable to the extensive catalogue of human ailments, there 
should not have occurred spasmodic and ill-adjusted theories, 
crystallizing in many a strange cultus, which, if ineffectual in 
retarding the onward sweep of rational progress, has, it may be 
safely averred, worked incalculable injury to the cause of medical 
truth. Mesmerism, astrology, spiritualism, even theosophy, how- 
ever incongruously conjoined, and similar vagaries have not failed 
to enlist among their votaries many enraptured, even noted, be- 
lievers ; nor is the mental strabismus with which they are afflicted 
amenable to any resource of rational treatment. We need, more- 
over, but contemplate the pitiable hallucinations which urge the 
pious pilgrimages to Marpingen, Lourdes, and Treves, and the 
criminal negligence and incredible oflence to reason which stultify 
the so-called " Christian Scientists " (as ironical a misnomer as lan- 
guage permits), to realize that miraculous cures still hold blighting 
yet potent sway over the minds of the ignorant and credulous. 
May not even the assumption of thaumaturgical powers be one 
day possible with those who arrogate to themselves a knowledge 
little short of omniscience, and to whose rudimentary intelligence 
the laws of nature convey no perceptible lesson ? As from the 
sublime to the ridiculous, so from faith to fanaticism, it is but a 
step, after all. 

It is appropriate here to emphasize the unfailing — nay, ever- 



INTRODUCTION. 19 

increasing — importance of therapeutics in its relation to the wel- 
fare of mankind. Especially imperative is this obligation in an 
epoch of unprecedented achievement in every department of science 
which contributes to the perfection of the healing art, in which 
general advancement medicine has borne no inconspicuous a role. 

The rapid advance of experimental philosophy, however, applied 
to medical treatment, culminating in bacteriological discoveries of 
signal value to mankind, and the remarkable triumphs attending 
the development of operative surgery, have inevitably tended to 
disparage the equally noble and far more widely cultivated field of 
therapeutic science. This result is the more deplorable since it 
creates in the minds of the young and inexperienced an impression 
of contrast and divergence in departments of study naturally and 
indissolubly correlated. It is scarcely surprising that the marvels 
of the laboratory and the splendid achievements of the arena should 
possess for the tyro an entrancing interest. Yet it is to be borne in 
mind that the most brilliant triumphs of diagnostic and surgical 
skill might prove futile as the means of arresting disease were they 
not supplemented by the course of treatment which constitutes 
therapy. 

It must be confessed that medical art has too often been dis- 
credited by professional incompetence, and consequent failure to 
effect the cure that with the laity is wont to form, however ignor- 
antly, the only criterion of ability. In America especially — where 
from defective laws the widest latitude is given to incapacity and 
imposture — the lack of proper academical training is frequently 
the cause of serious consequences in practice, little calculated to 
enhance the popular confidence and esteem. It therefore behooves 
the student of medicine to master thoroughly the details of the 
remedial art, become practically conversant with physiological 
conditions and the manifold phenomena of morbid anatomy, and 
so familiarize himself with the varying indications of disease that 
in the presence of whatever malady, his diagnosis and treatment 
may command respect — not only from the laity, but, what is of far 
more consequence to him, from the profession. 

It is almost superfluous to lay stress upon pharmaceutical know- 
ledge as a powerful weapon in the armament of the medical prac- 
titioner. Yet no branch of therapeutic science has, perhaps, been 
more neglected than a practical acquaintance with the nature and 
uses of Materia Medica, their origin, potency, and characteristic 
value, as well as their physiological action, and the incompatible 



20 A TEXT-BOOK OF MA TERIA MEDICA. 

and synergistic agents upon which their efficacy often largely 
depends. 

Thanks to careful and competent training among pharmacists, 
the skilful preparation and dispensing of drugs relieve the physi- 
cian of much responsibility ; yet he should be keenly sensible of 
the fact that the larger share of public confidence is reposed in 
him, and by diligent study of the subject endeavor to command 
the minutiae of pharmacology, holding himself morally accountable 
for errors quite possible in the druggist's dispensary. It may not 
be irrelevant to add that in all medical procedure a sympathetic 
yet perfectly controlled nature, ready tact, and sterling common 
sense are cardinal requisites to professional triumph, it being gene- 
rally true, as was long since observed by Hufeland, that " success- 
ful treatment requires only one-third science and two-thirds savoir 
faired 

Finally, the author would counsel the utmost seriousness in 
the pursuit of a calHng v/hich might aptly be termed " Christian 
Science " — the power to alleviate human suffering by means of 
curative agents with which the laboratory of nature has been 
mercifully stored. There can be no loftier, more practical mani- 
festation of love to men than is exemplified in the benignant effort 
to assuage the ills to which mortality is heir ; nor can any devotion 
be more privileged and inspiring than that which softens the shock 
of disease, illumines the darkness of mental and physical distress^ 
and from the debris of misfortune, vice, and heredity creates anew 
the image of divine perfection. It is this uplifting, consecrated 
zeal, akin to veneration for medical science, which has endeared to 
the world the masters of the profession — of which the same wise 
Hufeland said : " To him who fails to make a religion of the heal- 
ing art it is the most cheerless, wearisome, and thankless labor 
upon earth ; indeed, in him it must become the greatest frivolity 
and a sin." And for those — and they are many—to whom the 
material, possibly mercenary, aspect of their task appeals unduly 
it is enough to cite in rebuke the elevated maxim of Stigelius : 

Non omnia quae suscipimus lucrum spectant. 
\_Thurnbergii Di5sertationes.'\ 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 



Remedies. — In a comprehensive sense every means of counter- 
acting, curing, or mitigating disease or bodily disorder may be 
termed a remedy or remedial agent. The mode of treatment may 
be preventive, reparative, or restorative ; but the agents employed 
by the physician are properly called remedies. Although their 
number is wellnigh as great as the multifarious causes of disease, 
the chief classes of remedies are comparatively few, and may be 
grouped mainly under the following heads : 

Prophylactic, whereby attention is directed to the immediate 
environment of the patient, with a view to secure proper sanita- 
tion and outward conditions more favorable to recovery sug- 
gested by hygienic laws. 

Sanitary, when hygienic treatment is combined, as it now 
usually is, with medical remedies, constituting what is known as 
regimeit, including proper ventilation, temperature, diet, bathing, 
and exercise. 

Imponderable , as when the forces of light, heat, cold, and elec- 
tricity or magnetism are brought into requisition by the aid of 
science. 

Mechanical, pertaining to certain surgical methods and remedial 
applications, or a course of physical training, including the peculiar 
yet often efficacious treatment known as massage. 

Pharmaceutical, including a very large and varied class of 
remedies which, from their established curative properties and 
their signal importance to the physician (medicus), are technically 
termed medicines. They are designed to preserve or restore the 
health of the animal organism, promote recovery in cases of injury 
or disease, and, in short, perform every office proper to a palliative 
or remedial agent. 

Physiology is the study of the functions of the different organs 
of the animal body under normal conditions. 

Pharmacology is, strictly speaking, the study of the functions 

21 



22 A TEXT-BOOK OF MATERIA MEDICA. 

of the different organs of the animal body rendered abnormal by 
drugs. 

Materia Medica deals especially with the sources from which 
drugs are derived, their chemical and physical properties, their 
constituent elements, and their general function as substances or 
agencies in the practice of medicine. 

Pharmacy is restricted to the analysis and determination of 
drugs, and the science .of preparing and dispensing medicines in 
the forms in which they are best administered. 

Pathology is the study of the animal body rendered abnormal 
by disease. 

Therapeutics (from the Greek word meaning to attend, to serve^ 
is the study of the diseased body under the influence of remedial 
agents and the science and practice of selecting and applying 
remedies for sickness and disease, and necessarily includes the 
proper care and treatment of invalids. " The ultimate aim of all 
medical research," it has been truly said, " is the treatment and 
prevention of disease." This constitutes the primary object of the 
therapeutist. 

In its amplest signification therapeutics embraces all that relates 
to the science and art of healing, and the application not only of 
medicines, but of every remedial agent likely to accomplish this 
paramount motive of the physician's labor. Under the general 
term of therapeutics, therefore, are included the action of natural 
forces, the varied resources of Materia Medica, and the contingent 
considerations of climate, food, clothing, etc., grouped under two 
principal divisions : 

Natural Therapeutics, being, as the term implies, a curative 
method dependent upon the laws of nature rather than the sub- 
sidiary arts of man. 

Applied Therapeutics, including the scientific application of 
palliative or remedial agents having no counterpart in the living 
organism, designed, through the art of medicinal administration, to 
assist nature in the process of restoring health. This division con- 
stitutes more properly the study of therapeutics and the domain of 
professional practice. 

Empirical Therapeutics implies the application of remedies to 
which experience has ascribed certain specific properties irre- 
spective of systematic value. It is not based upon scientific 
research, but rather upon formulae established by the accumula- 
tion of isolated facts — empiricism — and practical observation, apart 



PHARMACOLOGY AND GENERAL THERAPEUTICS. 23 

from theoretical reasoning and the relations of physiological 
phenomena as revealed by modern methods of investigation. 
Were it possible to extend indefinitely the list of remedial agents 
so as to embrace the entire field of therapeutic knowledge, the 
empirical method might attain the dignity of an exact science. 
Such, however, is the complexity arising from the manifold, often 
contradictory, impressions drawn from human experience that for 
the evolution of a systematic scheme of therapeutics the empirical 
system must of necessity prove inadequate. 

Rational Therapeutics is based upon the use of medicines in 
accordance with a scientific knowledge of pathology and the physi- 
ological effects of remedial agents. Here nothing is left to chance, 
and the nostnims of the older system have but little weight com- 
pared with the methods of careful and intelligent diagnosis and a 
skilful administration of remedies suggested by well-known and 
accepted indications of disease. Every department of medical sci- 
ence has been illumined by the light of modern research, and the 
chemical and physical properties of Materia Medica submitted to 
severe and competent analysis, that Rational Therapeutics may 
establish a system through which the errors and uncertainty of 
empiricism may be supplanted by a more stable and philosophical 
method, and the chances of inaccuracy minimized. Through the 
college curriculum and the medium of professional intercourse, 
afforded by personal comparison of opinions and by innumerable 
publications throughout the world, the results of scientific experi- 
mentation are becoming widely diffused and the scope of serious 
investigation constantly enlarged. 

In connection with this subject it may be well to call the atten- 
tion of the student to the technical signification of the following 
terms : 

Pharmacopoeia (^pharmakoii, drug ; poiei^t^ to make), a book com- 
piled by the government, or, as in the United States, a National 
Committee on Revision, and published by authority, establishing 
standards for the identification, purity, strength, and quality, and 
giving directions for the purification, valuation, preparation, com- 
pounding, and preservation of drugs, chemicals, and medicinal sub- 
stances. The United States Pharmacopoeia is revised decennially, 
the present (nth) edition having been adopted Jan. i, 1894. 

Official — Officinal. — Unnecessary confusion prevails concerning 
the precise import of these terms. They are readily understood 
by reference to the Latin originals from which they are derived. 



24 A TEXT-BOOK OF MA TERIA MEDIC A. 

Official drugs are those which bear the stamp of professional — 
i. e. official — sanction (Lat. officium, authority). They are prac- 
tically ordered by the Pharmacopoeia to be kept in all druggists' 
shops, the formulae being supplied by the work revised in decennial 
conventions. 

Officinal drugs are those prepared or kept by the druggist upon 
his own responsibility, bearing only the authority of the shop (Lat. 
officina, a shop). Such preparations are often included in works on 
Materia Medica, and, together with those emanating from other 
individual formulae, are marked " unofficial." 

The term " unofificinal," it will be seen, is a solecism ; and it fol- 
lows, moreover, that there are many preparations which are in 
pharmacy officinal, but not official, and that a pharmacopoeial 
formula cannot possibly be officinal, although, speaking generally, 
all official drugs are officinal in that they are kept or prepared in 
the druggist's shop. 

Dispensatory. — This is a compilation of and commentary on 
one or more pharmacopoeias, enlarging the authoritative but re- 
stricted pharmacopoeial formulae by including the medical and 
physical history of the various substances, with directions regard- 
ing dosage, together with observations on their physiological action 
and therapeutics. It also contains information concerning drugs 
not accepted by pharmacopoeial authority, yet which are of occa- 
sional use or interest. The Dispensatory is in effect a private pub- 
lication and unofficial, in this respect differing essentially from 
a pharmacopoeia. There are in the United States various works 
of this character, the United States and National Dispensatories 
being commonly in use. 



CLASSIFICATION OF MEDICINES. 

The classification of drugs arwd remedial agents is a theme 
regarding which the many writers upon and teachers of medicine 
have shown a wider diversity of opinion, perhaps, than upon the 
physiological action and medical uses of individual remedies. The 
fact that therapeutics is far from being an exact science, and the 
rapid advance in our knowledge of normal physiological processes, 
of pathological conditions, and the systematic action of drugs, are 
sufficient explanation of the ever-changing judgments of our 
best observers concerning the action of certain medicinal agents 
under given conditions. 



CLASSIFICATION OF MEDICINES. 25 

It follows that from time to time, as appears in reviewing the 
literature of the subject, different writers, in their attempt to keep 
pace with the advancement of knowledge, have devised various 
systems of classification. 

In earlier days, when the therapeutist culled from the fields his 
simples for the cure of disease, there was naturally created a strong 
tendency toward a botanical classification. So far was the system 
pushed that in certain so-called schools of medicine the authority 
of Scripture was invoked, it being proclaimed as an axiom that 
''* the leaves of the tree were for the healing of the nations " (Rev. 
xxii. 2). This eclecticism, strange as it may seem to-day, was the 
outgrowth of the Thompsonian or Botanical system of therapeutics. 
On the other hand, as an evolution of the old alchemic school, an 
attempt was made to found a classification by explaining the 
remedial action of all medicines upon a purely chemical basis. 

With the advent of more modern methods of study, appHed to 
the physiological action of drugs upon the animal economy, came 
the physiological classification, in which the effects of remedial 
agents were explained upon rational grounds. 

It is hardly necessary to state that coexistent with these various 
-endeavors to attain a philosophical method of classification, com- 
pHcating them and perplexing their votaries, the dominating prin- 
ciple of empiricism held universal sway, setting at defiance in many 
instances the cardinal maxims of rational therapeutics, the rational 
therapeutist even to-day welcoming as a last resort the cruder, 
though often efficient, empirical method. 

Some authors, perceiving the inutility of the older systems, 
have contented themselves with a mere alphabetical arrangement 
of medicinal agents, regardless of their origin, natural affinities, 
mode of preparation, and physiological action. 

With due respect for the many able and worthy efforts at 
classification recorded in the history of modern therapeutics, the 
author believes that the main object of classifying medicinal reme- 
dies — viz. to facilitate the retention of a vast number of valuable yet 
isolated facts — is best accomplished by grouping them along the 
lines of greatest practical utility. 

Remembering that the medical student of to-day is animated by 
an earnest effort to fit himself for the noblest sphere of usefulness 
— knowledge applied to the relief of human suffering — the author 
holds that the most philosophical, as well as practical, synthesis 
and comparison of remedial agents, based upon manifest physical 



26 A TEXT-BOOK OF MA TERIA MEDICA. 

and physiological relationships, will afford to the pupil the widest 
grasp, from a therapeutical standpoint. 

With the object of aiding the student, in accordance with this con- 
viction the author has endeavored in this work to give emphasis to 
a therapeutical classification, claiming for it no especial originality,^ 
but assured that the method he has selected is alike the most judi- 
cious and the one best calculated to respond to the demands of 
daily, practical utility. 

The thoughtful and logical student of medicine must realize that 
there are two great classes of remedial agents : 

I. Those used in cases which cannot be reHeved by a single 
dose of any remedy, but require repeated and prolonged admin- 
istration. 2. Those employed in cases which are susceptible of 
immediate relief by the exhibition of a single dose. 

The remedies employed for the cure of the first class of cases 
have been appropriately styled Disease- or Organic- Medicines — an 
unscientific term, perhaps, yet useful to convey the intended idea, 
since they remove the cause of the departure from normal physio- 
logical action in the living organism — i, e. perversion of functional 
integrity, or morbid conditions. 

Upon reflection it will be seen that remedial agents in the second 
class are, by the nature of the case, designed for the relief of some 
manifestation or change in the system or in its functions indicating 
the character, locality, severity, etc. of a morbid process — a symp- 
tom of disease. The remedies in this class, therefore, are termed 
Symptom- or Functional-Medicines, partly because of their specific 
virtue in relieving symptoms, partly from the fact that they produce 
certain manifestations characteristic of themselves. 

Disease-Medicines are usually administered for the relief or cure 
of chronic diseases. Symptom-Medicines are employed to relieve 
symptoms of, or prevent complications in, acute diseases — not for 
the cure of the disease itself. 

The classes named might be subdivided ad infinitum, yet it has 
seemed advisable to the author, for the sake of simplicity, to divide 
only the first class, Disease-Medicines, including the remedial agents 
employed therein, under three general heads, Restoratives, Altera- 
tives, and Antiseptics. 

It is obvious to every reflecting physician that a class of reme- 
dies act as such by supplying some deficiency in the animal organ- 
ism, the agent in such cases being either itself the substance 

1 This classification is adapted from one formerly used by Prof. William N. Thomp- 
son of New York. 



CLASSIFICATION OF MEDICINES. 27 

lacking, or its analogue, or by its presence restoring the deficient 
element or secretion. Iron or fats, for instance, act in certain forms 
of anemia in which these ingredients are wanting in the red blood- 
corpuscles ; phosphorus or the earthy salts behave similarly in 
conditions where the tissues are deficient in these necessary constit- 
uents; and bitters, though not natural ingredients of the system, 
act upon the gastro-intestinal mucous membrane, stimulating the 
glands to secrete a larger quantity of normal digestive fluid. 

In view of the physiological action of the remedies pertaining to 
this division, the term Restoratives so aptly expresses their general 
character that no apology is needed for its adoption. 

The second division. Alteratives, can be administered without 
injurious results only in diseased QoridAixon?,, in which the particular 
remedy combats in a specific and occult manner the prime etiologi- 
cal factor of the pathological derangement. These medicines act 
properly only upon diseased organisms, their peculiar effect never 
being obtained by the exhibition of a single dose, but only after 
prolonged administration. They are unnatural to the system, and 
are more or less poisonous. Functional medicines are also un- 
natural to the system, but they are given only to relieve symptoms 
of disease, not for the disease itself; whereas Alteratives relieve the 
symptoms by removing the cause of the disease. The latter nor- 
mally produce no symptoms, the patient being unaware of their 
action save by a recognition of his gradually improved condition. 
Should, in fact, symptoms occur, they should serve as a warning 
that the remedy is not indicated or that the dose is unsuitable. 

To elucidate this principle, the use of morphine to allay the pain 
of gout may be cited. A single dose is usually sufficient, yet it is 
not curative ; while colchicum acts as an alterative through its 
well-known specific and eliminative properties, and by continued 
treatment cures the disease. Again, caffeine may be employed to 
relieve anemic neuralgia, yet it may require hemic restoratives to 
alleviate the morbid condition producing the symptoms. 

A genuine alterative seems to have the property of antagonizing 
some disease. For instance, A and B are put under a prolonged 
course of mercury : A is salivated beyond recognition, while B's 
health improves — simply for the reason that B had syphilis, which 
A had not. At present the number of remedies which we are 
compelled to relegate to this class. Alteratives, for want of accu- 
rate knowledge regarding their modus operandi, is quite limited. 

The second great class of agents to which the name Symptom- 



28 A TEXT-BOOK OF MATERIA MEDICA. 

Medicines is applied embraces all medicinal substances which, 
being introduced into the system, may produce by a single dose 
abrupt or serious disturbances of function. From the earliest his- 
tory of medicine they have offered a tempting field to the thera- 
peutist, because of the absolute certainty of their action in allaying 
symptoms or producing manifestations pecuHar to themselves. It 
is perhaps superfluous to add that, owing to their extreme activity, 
the greater number of therapeutic errors may be ascribed to their 
use. 

To the young practitioner the charm of therapeutics lies in that 
class of agents which produce immediate and tangible results. 
These are obtained most readily by the remedies affording instant 
relief of prominent symptoms of disease, such as pain, pyrexia, 
insomnia, etc. Yet the author is here constrained to add a word 
of caution to the amateur therapeutist, reminding him that, in the 
maturer knowledge derived from subsequent experience, he will 
have Less to regret should he confine his study and practice to 
physiological medication — that is, to the examination and adminis- 
tration of legitimate restoratives and alteratives — rather than yield 
to the allurements presented by the energetic action of a large 
number of agents classed among Symptom-Medicines. 

The members of this class of remedies have been variously 
divided and subdivided by different writers on therapeutics. 

Antiseptics are classed among Disease-Medicines on account of 
their property of restoring to their normal condition the tissues, 
fluids, and secretions of the body by destroying the germs or 
micro-organisms which by their presence excite pathological 
processes. 

This great class, Antiseptics, embraces some of our most important 
neurotics. Most of them are antipyretic, and many of them possess 
analgesic and hypnotic properties. Instance, chloral, a powerful 
antiseptic, hypnotic, antipyretic, and circulatory depressant. Con- 
sidered only as an antiseptic, it would be classed as a Disease- 
Medicine ; clinically, however, it is used more as a hypnotic, and 
therefore in this work it is ranked as a Symptom-Medicine — a 
neurotic in the subdivision of Hypnotics. 

Drugs, in fact, exhibit so many different actions that an arbitrary 
line of demarcation between them is practically impossible, the 
author merely desiring to assign a given remedy to the class to 
which its chief therapeutic uses would naturally attribute it. 

The principal use of opium, as we know, is to relieve pain. It 



ADMINISTRATION OF MEDICINES. 29 

is the typical narcotic, yet it possesses astringent and hypnotic 
properties, and could therefore not inaptly be classed as an astrin- 
gent or hypnotic. 

It is already a question whether antipyrine should not be ranked 
in the division of Analgesics rather than Antipyretics, since, while 
formerly it was used almost exclusively for the reduction of tem- 
perature, we now know it to possess marked anodyne properties ; 
so that it is actually doubtful which is its more important use — to 
lower temperature or to relieve pain. 

These few illustrations serve to show how varied are the actions 
of drugs, and how their several divisions overlap one another. 
Thus, the last division of Disease-Medicines, Antiseptics, imme- 
diately precedes the first group of Symptom-Medicines, Antispas- 
modics, so closely are they aUied, the last-named class possessing 
properties similar to those of that interesting division of Antisep- 
tics — the Aromatics. 

The next group, Antipyretics, is logically followed by Anes- 
thetics, and this in turn by Hypnotics, Narcotics, etc., each group 
being succeeded by the one most closely resembling it in physio- 
logical and therapeutic action. The last group comprises the 
Astringents, classed under Symptom-Medicines, these agents occu- 
pying the borderland between external and internal medicines. 

Caustics, the first group under topical remedies, naturally follow 
Astringents, since they differ from the latter drugs only in degree 
perhaps, as is well shown in sulphuric acid, which when diluted is 
an astringent, but undiluted an active caustic. 

A thoughtful study of drugs as classified in this work will, it is 
hoped, enable the student to become more familiar with the com- 
parative value of the various remedial agents than were possible 
had the author chosen an alphabetical arrangement, associating 
remedies having no possible relationship either in their actions or 
their medical uses. 



ADMINISTRATION OF MEDICINES. 

External Method of Application. — In order to utilize the 
absorptive power of the cutaneous surface for therapeutic pur- 
poses various methods have been adopted. The simplest of these, 
though by no means the most successful, is by 

Inunction, which consists in an outward application of the 



30 A TEXT-BOOK OF MATERIA MEDICA. 

medicinal agent, without abrasion of the cutis, and compulsory 
absorption through the process of ''rubbing in." The horny 
epidermis, however, presents an effectual barrier to the absorption 
of many drugs, and the 

Endcnnic Method has been found more active. This plan con- 
sists in producing, by means of a blister, a raw surface, which 
readily absorbs the medicinal agent — morphine, strychnine, atro- 
pine, quinine, etc. — with highly marked effect. The process is 
somewhat painful and necessarily slow in action, being now almost 
wholly superseded by the 

Hypodermic Method. — This consists in injecting the drug into 
the subcutaneous tissues by means of the hypodermic needle and 
syringe. Since absorption by the tissues takes place readily, it will 
be seen that this method of application is far more efficacious than 
those previously mentioned. Not all drugs, it is to be observed, 
are available for administration by the hypodermic process of 
injection. The eminent success attending the operation, however, 
renders it of signal value to the physician. 

Parenchymatous Method. — This is a more heroic means of 
injection, by which the drug is deposited in the corporeal tissues. 
It is said to afford temporary relief in sciatica, but for various 
reasons is highly objectionable, chiefly because of the excruciating 
pain consequent to the operation. 

Intravenous Injection may be resorted to in desperate cases : its 
dangers are obvious, however, and, save for the purpose of trans- 
fusion after severe hemorrhage, it can seldom be attempted with 
impunity. 

Internal Administration. — The most obvious, and by far the 
most useful, method of internal administration is by the mouth ; 
yet care and discretion are to be used even in so ordinary a process, 
and the physician should consider thoughtfully the time, consequent 
effects, and chemical changes, that the drug may produce the most 
beneficial results. 

Inhalatio7i is in many respects of the first importance as a 
method of internal administration. Its great facility in practice 
and its unquestionable efficiency — as in the case of anesthetics — 
render it readily available and highly beneficial, although the 
method has attained as yet only a limited use in therapeutics- 
beyond a resort to it in pulmonary diseases. 

Eiiemata. — A different class of administrative operations consists 
in injections into the rectum, which injections may be purgative, 



ADMINISTRATION OF MEDICINES. 31 

anodyne, nutrient, emollient, astringent, anthelmintic, etc. For 
speedy and efficient cleansing of the large intestine the purgative 
enema is of incomparable value, care being taken that the quantity 
of the injection be sufficient, that it be passed up as far as possible, 
and that it remain as long as the patient is able to retain it. 

Absorbable enemata are usually small in quantity ; they have 
proved useful in certain cases of diarrhea and dysentery, and are 
serviceable when the act of swallowing is precluded by affections 
of the esophagus or in cases where the stomach requires complete 
rest. The rectum, however, possessing no digestive capacity, the 
injection should consist of the simplest materials and contain pepsin 
and acid or pancreatic fluid. 

Another mode of securing beneficial results from internal admin- 
istration through the absorptive properties of the intestine is by 
means of suppositories, readily introduced within the sphincter ani 
and dissolving at the temperature of the body. 

Dosage. — The term dose implies the quantity of a medicinal 
agent which under certain conditions it is advisable to administer, 
many considerations entering into the question, to be weighed by 
the features of the individual case. Dosage may be regarded as 
perhaps the most vulnerable point in therapeutic science, yet one 
upon which the art of healing almost wholly depends. 

Since Heller in 1755 enunciated his philosophical maxims 
touching the rational method of testing the therapeutic effects of 
drugs, eminent clinicians have sought to solve the mysteries attend- 
ing the action of various remedies whose modus operandi remains 
to this day obscure. Indeed, so great is the diversity of operation 
pertaining to the commonest remedies, conditioned by the character 
and circumstances of the case, as well as the amount and quality 
of the drug, that it is next to impossible to predicate the precise 
effects of agents whose physiological properties are theoretically 
and even practically established. The ordinary adult dose of 
opium, for instance, is i gr. (0.06 Gm.) ; yet in certain diseases, 
such as peritonitis, ten times that amount may be required to 
relieve the pain. The doses given in many text-books differ 
materially from those prescribed in actual practice, being in- 
tended to express only the average quantities to be admin- 
istered, the exact amounts varying with the conditions of the 
particular case. These conditions may be classed under the 
heads of age, sex, temperament, idiosyncrasy, habit, state of the 
system, temperature of the body, time of administration, intervals 



32 A TEXT-BOOK OF MATERIA MEDIC A. 

between doses, cumulative action of the drug, and the contingent 
considerations of diet, climate, race, etc.— oftentimes a complicated 
problem even to the most skilful therapeutist. A few suggestions 
regarding the leading characteristics of dosage, as limited by these 
various circumstances, may be of value to the student. 

The influence exercised by Age is indubitable, as a rule the 
young requiring smaller doses than adults, the aged being least 
susceptible to therapeutic impressions. With regard to children 
several mathematical formulae have been devised, none of which, 
however, has proved infallible— least of all those based upon 
adult dosage, itself subject to no litde uncertainty. Nor can 
deductions as to the efficacy of a given dose be drawn from 
the action of drugs with which the agent is naturally asso- 
ciated. A single drop of laudanum has been known to pro- 
duce the death of an infant, whereas large doses of belladonna, 
conium, arsenic, and mercury have been taken with comparative 
impunity. 

The most convenient rule (Young's) adds 12 to~the child's 
age and divides by the age to get a denominator of a fraction 
whose numerator is i, this fraction representing the proportion 
between adult and infant doses. Thus, for a child three years old 

3+12 

- — = 5, or ^, the dose being one-fifth of that given to an adult. 

Temperament acts as an important agent in modifying the effect 
of medicinal remedies, phlegmatic subjects readily tolerating cer- 
tain medicines, such as opium, which those of nervous temperament 
are unable to bear. Stimuli act upon sanguineous patients forcibly, 
yet upon others their influence may be either tardy or ineffectual. 
The condition is one which discloses a wide field of inquiry, the 
mental, moral, and physical tendencies of the individual being 
involved in the practical administration of medicines. 

Closely aUied to the foregoing is the question of Idiosyncrasy , the 
constitutional peculiarity which exerts a subtle influence, scarcely 
understood, as potent as it is obscure. Its characteristics cannot 
be formulated, but must be studied with the aid of experience — an 
odor, a taste, a casual or fixed impression, or hereditary instinct 
often determining their existence and manifestation. In tempera- 
ment and idiosyncrasy, indeed, the psychological rather than the 
.physiological side of therapeutics is developed, requiring for its 
treatment a professional acumen not always at command. 

The influence of Habit is to diminish the susceptibility of the 



ADMINISTRATION OF MEDICINES, 33 

organism to impressions which under normal conditions would be 
speedy and effectual. Only by gradually increasing the quantity 
of the dose can results be obtained which in ordinary circumstances 
require few exhibitions. Thus, patients accustomed to the use of 
alcoholic stimulants accept heroic doses of alcohol with little or no 
indication of effects quickly perceptible in temperate subjects. 

Bodily condition obviously affects the action of remedial agents. 
It is well established that in severe pain opium may be adminis- 
tered in quantities which in a healthy organism would produce 
untoward, perhaps fatal, results. The salivation occasionally caused 
by mercury is seldom apparent in febrile conditions. Yet in cases 
where sensibility is diminished great care is necessary to avoid the 
deleterious effects of over-stimulation or excessive dosage. 

Respecting Sex, although it is generally admitted that females 
require smaller doses than males, the exceptions to the rule are so 
numerous as almost to vitiate the accepted theory. 

The Time of Administration is closely connected with the Form 
of the Remedy given, as a rule remedies being withheld immedi- 
ately before and after meals. The practice, however, is subject 
to modifications, certain drugs acting best on an empty stomach, 
and others, such as local irritants, being more safely diffused when 
the stomach is full, in which case by mingling with the food they 
are not brought into irritating contact with the intestinal mucous 
membranes. 

With regard to Intervals between Doses it may be said, in brief, 
that they are to be determined by the special features of the case, 
the character and potency of the drug, and the degree of tolerance 
and assimilation evidenced by the patient. Every remedial agent, 
under normal conditions, produces a specific and definite action, 
the system by absorption and ehmination limiting the period of its 
efficacy in cases of prolonged treatment, so that the drug is evi- 
dently to be renewed in order to secure perfect results. Failure to 
continue treatment has frequently proved disastrous, even fatal, to 
the patient, and it should be borne in mind that, in the absence of 
contraindications or untoward effects, a primary object of dosage is 
to create and maintain an impression upon the morbid system. 
Knowledge of therapeutic action and a thorough understanding of 
pathological conditions can best determine the interval requisite to 
attain the most beneficial effect of successive dosage. 

Other considerations — by some therapeutists held to be of 
minor, by others of paramount, importance — affect the vital question 



34 A TEXT-BOOK OF MA TERIA MEDICA. 

of dosage. The emotions, for example, play an interesting part in 
the toleration or rejection of remedial agents. Strangely enough, 
too, the imaginative faculty is often a cause of idiosyncrasy, numer- 
ous instances being adduced by reputable authorities wherein 
either positive or fancied ills were affected through the agency of 
spurious remedies — bread-pills, deceptive concoctions, and the like 
— the ethical aspect of therapeutics being here left to the conscience 
of the physician. 



UNTOWARD EFFECTS OF DRUGS. 

Drugs given a specified patient, a victim of acquired or in- 
herited defect, will produce in that patient unexpected results dif- 
fering from their usual action. These results, which should not be 
classified with typically poisonous effects or with those of pro- 
longed use, may not appear in many cases, and do not correspond, 
as a rule, with the admittedly poisonous symptoms. They have 
been termed in Germany " nebenwirkungen," in France " incon- 
venients therapeutiques," and among the English-speaking nations 
*' untoward effects" and "bye-effects." The following summary 
has been made of these from those tabulated by Drs. W. L. Baum, 
and J. G. Kiernan of Chicago, Lewin of Berlin, Germany, and Mul- 
heron of Detroit, Mich. 

Untoward effects are of great interest from a medico-legal 
standpoint. Even physicians are but too apt to refer them to 
defects or impurities in the drug dispensed. They are seemingly 
multiform in character, and yet they can readily be ranged under a 
few general laws. The primary and secondary effects, which are 
often opposite in nature, the organs chiefly affected by the ordinary 
action of the drug, the method of drug-excretion, all play a part in 
what may be called general constitutional untoward effects, as con- 
trasted with the untoward manifestations due to temporary and 
evanescent conditions, which last, however, also range themselves 
in a regulated fashion. 

Prediction may be made with considerable accuracy as to the 
untoward effects of any drug on learning its action and all the 
factors cited. An antipyretic will have as untoward effects, skin- 
eruption because it is excreted through the skin, because the skin 
through its pores regulates temperature, and hence is under control 
of the central nervous system regulating temperature, and, finally, 
because the skin is in close connection from an early period with 



UNTOWARD EFFECTS OF DRUGS. 35 

the nervous system. For the same reason profuse, debihtating 
perspiration often results. Since control of the temperature cannot 
be effected without control of the vasomotor system regulating the 
blood-supply, heart-failure, collapse, and palpitation may result, 
together with certain eye- and ear-symptoms. 

If the drug be one which tends to cause slight brain vasomotor 
disturbance, such as results from what is known as a tonic action, 
then delirium, blindness, and deafness of a temporary character are 
produced. Temperature in the human subject is regulated by the 
three systems of nerves : thermotaxic or heat-regulating, thermo- 
excitory or heat-increasing, and thermo-inhibitory or heat-decreas- 
ing. As a more or less exact balance is kept by these centers, undue 
action of any of them constitutes a morbid state. If the thermo-in- 
hibitory centers be too much stimulated, they may lose their control : 
hence in certain individuals temperature rises after an antipyretic. 

Hahnemann, an individual with a neurotic constitution, had an 
easily upset temperature-regulator, whence his experiments on him- 
self with cinchona resulted in this phenomenon, which has since 
been observed by Denk and others from quinine and cinchona 
preparations. The action on the heart may, by its influence on the 
kidney-circulation, cause kidney- and bladder-symptoms even to 
the extent of albumin in the urine. If the antipyretic be excreted 
through the kidneys, albuminuria is especially likely to present 
itself as an untoward result. Alteratives and purgatives produce 
hemorrhages from the mucous membranes and swelling of those 
of the organs of special sense, beside skin-eruptions. Hypnotics 
through their action on the central nervous system produce exces- 
sive perspiration, skin-eruptions, vertigo, and heart-collapse. Astrin- 
gents cause diarrhea and bloody intestinal discharges. Diaphoretics 
cause pains at certain points from over-stimulation. Pilocarpine 
causes at times pain in the penis ; as there often occur in certain 
persons excessive secretion and plugged sebaceous glands around 
its head, the pain and other resultant symptoms simulate chancre. 

In classifying tonics and alteratives together in the first table the 
influences of the trophic nervous system, evident in the constitu- 
tional changes produced by diseases like typhoid fever, must be 
taken into account. Alterative drugs have much the same con- 
stitutional effects, according to the theory of their action now 
coming into general acceptance. 

It will be observed from the annexed tables (see pages 36-41) 
that the most potent tonics and alteratives are most fertile in 



36 



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38 



A TEXT-BOOK OF MATERIA MEDICA. 



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40 



A TEXT-BOOK OF MA TERIA MEDICA. 



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Like methacetin. 
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43 A TEXT-BOOK OF MATERIA MEDICA. 

untoward effects. This is naturally to be expected. A drug of 
potent physiological action must of necessity try more severely 
inherited and acquired deficiencies of constitution than an inert 
drug. Too excessive strain on inhibitions weakened by acquired 
or inherited taint gives an undue sway to inhibited centers. Un- 
toward effects of drugs may hence be conditioned on pre-existing 
affections of the inhibitory apparatus of the system. 

One influence which, together with hereditary or acquired 
defect, plays a part in determining untoward results is what 
the Germans call the " etiologic moment." This is excellently 
illustrated in the neurotics, which display such decidedly variable 
untoward effects. In many neuroses nerve-strain of the elimi- 
native and assimilative organs has produced toxins and other 
products ; some of these naturally add to the effects of a given 
neurotic drug, or direct these in some special channel or inhibit 
certain effects, thereby giving others undue play. This may con- 
stitute, as Lewin has shown, a disposition that is but temporary, 
which disposition may have its foundation either in a greater 
abundance in the system of bio-chemical substances, which cause 
an unusually prompt solution or action of the medicines intro- 
duced, or which may unite with them to form injurious com- 
pounds ; or it may be conditional on pre-existing pathologic 
changes in the inhibitory apparatus of the system. 

The tables given on pages 36-41, covering all the departments 
of the materia medica, will give a better idea of these untoward 
effects than any detailed description. 



WEIGHTS AND MEASURES. 

The history of Weights and Measures affords a striking example 
of the incongruity resulting from the absence of a uniform standard 
of stable value to science, and must be regarded as the strongest 
argument in favor of the Metric, or Decimal, System. 

An idea of the confusion prevailing under the old methods may 
be gained from an examination of their comparative units, by which 
we find that a pint is not a pound, an ounce not equal to a fluid- 
ounce, a drachm not equivalent to a fluidrachm, and a minim not 
commensurate with a grain. It was not until 1836 that the Secre- 
tary of the U. S. Treasury was directed by Congress to furnish each 
State in the Union with a complete set of revised standards, includ- 



WEIGHTS AND MEASURES. 43 

ing the troy pound of 5760 grains, from which the Apothecaries', 
or Troy, weight is derived, the latter term at present being appHed 
only to the system used in weighing precious metals. 

For commercial purposes the following Weights and Measures 
are employed : 

Avoirdupois Weights : the Pound divided into 16 Ounces. 

Liquid Measures : the "Wine Measure," of which the U. S. 
Gallon represents a volume of 231 cubic inches; each cubic inch 
of water at the maximum density (4° C.) being equivalent to 
252.892 grains, the weight of a Gallon being therefore 58,418 
grains. The Gallon is divided into 8 Pints (octarius), and the Pint 
is divided into 16 Fluidounces, each containing 8 Fluidrachms, 
or 480 Minims, the Fluidrachm containing 60 Minims. The signs 
used to designate these units are — TTL, denoting minim or minims ; 
f3, fluidrachm or fluidrachms ; and f 3, fluidounce or fluidounces. 

Apothecaries' (Wine) Measure. 

20 grains (gr. granuni) = i scruple 9 (scrupidum). 
60 grains, or 3 scruples = i drachm 3 (drachna). 
480 grains, or 8 drachms = I ounce E (^iftcia). 
5,760 grains, or 12 ounces = i pound R) {libra). 

Apothecaries' (Troy) Weight. 

60 minims (TTL) = i fluidrachm f^. 

480 minims, or 8 fluidrachms = i fluidounce f^. 
7,680 minims, or 16 fluidounces = I pint O {octarius). 
61,440 minims, or 8 pints = I gallon C {congius). 

This lack of uniformity in the units and the denominations of 
the three systems of weights and measures is exemplified in the 
subjoined table. While the two weight systems have a unit in 
common, the grain, there is no correlation in the higher denomina- 
tions, ounces and pounds. The desirability of adopting a fixed 
standard, applicable in all cases where great accuracy in weights 
and measures is requisite, has been frequently emphasized by 
writers on therapeutics. As we have premised, the present diffi- 
culty forms a cogent argument in favor of the metric system, as 
wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- 
parity is shown in the liquid measures, in which there is no unit 
in common : a minim is not a grain, nor ** a pint a pound the world 
around." 



44 



A TEXT-BOOK OF MA TERIA MEDICA. 



Table of Apothecaries' Weight and U. S. Liquid Measure, showing the 
equivalents of the various denominations (by reading from the left-hand column 
and referring to headings), the weight equivalent of liquid measures being for water 
at 15° C. : 



Symbol. 


Minim. 


Granum. 


Scru- 
pulus. 


Drach- 
ma. 


Fluid- 
drachma. 


Av. 
ounce. 


Fluid- 
uncia. 


Uncia. 


i Av 
Libra, pound. 


Octa- 
rius. 


Con- 
gius. 


m- 


I 


0.95 




57 


60 




480 






7,680 


61,440 


gr- 


0.95 


I 


20 


60 


57 


437-5 


456 


480 


5,760 7,000 


7,300 


58,400 


3 


. . 


20 


I 


3 








24 


288 


350 






5 


63 


60 


3 


I 




l¥n 


, 


8 


q6 


::3 


. 




f5 


60 


57 




\l 


I 


Ti 


8 


^ 


100 


128 


1024 


av. oz. 




437-5 




7/* 


7f 


I 


I'tV 


0.9115 


n* 


16 


16H 




fl. 5 


480 


456 






8 


■ii 


I 








16 


128 


S 




4«o 


24 


8 




itV 




I 


12 


14.S8 






lb. 




5,760 


288 


96 


. . 








I 


1. 215 






lb. av. 




7,000 


350 


ii6§ 




16 




14.58 


0.823 


I 






0. 


7,680 


7,292 






128 




16 






. , 


I 


8 


Cong. 


61,440 








1,024 




128 








8 


' 




Minim. 


Grain. 


Scru- 
ple. 


Drachm. 


Fluid- 
drachm. 


Av. 
oz. 


Fluid- 
ounce. 


Apoth. 

orTr. 

oz. 


Apoth.! Ay 

o'-Tr.! pound, 
pound. 1^ 


Pint. 


Gal- 
lon. 



THE METRIC SYSTEM. 

The Metric System of Weights and Measures, destined to sup- 
plant all others, originated with Prince de Talleyrand, bishop of 
Autun, in 1790. Its almost universal adoption by civilized nations, 
its legality, though not compulsion, in England and the United 
States, and its adoption by the U. S. Pharmacopoeia of 1890, 
require that it should be understood ahke by the physician and 
the druggist. Save in the EngHsh-speaking world it is the only 
system used for governmental, statistical, and scientific purposes, 
and in the arts and manufactures its value has long since been 
recognized. Its extreme simplicity, its uniformity, and its facility of 
computation render it far superior to any other system of Weights 
and Measures, and it is highly probable that in the near future it 
will prevail in the transactions of every-day life, as it has already 
acquired international importance, and is in fact referred to as the 
International System. 

The starting-point is the tiTtit of length, the meter (inetre), which 
is the 40-ToVo o"o" P^^^ ^^ ^^^ earth's circumference around the poles.^ 
From this apparently irrelevant measure of length the unit of 

1 In 1806, Frangois Arago and Biot were commissioned by the French government 
to complete the meridional measurements interrupted in 1804. The object of their 
survey was to determine, with as great nicety as possible, the ten-millionth part of a 
quadrant of the meridian passing through Paris, which had been chosen by the National 
Convention as the standard unit of length, and named the 7net7'e. It being impossible to 
measure from the poles, an arc of the meridian, equalling a quadrant, from Dunkirk to 
Barcelona was selected, and from their known difference of latitude the entire length of 
the arc was deducted. 



WEIGHTS AND MEASURES. 45 

capacity, or volume, the liter, was established, it being the cube of 
-^ oi 2. meter. With equal simphcity and clearness, from the meter 
was derived the unit of weight, the gramme, which is the weight 
of that quantity of pure water at the maximum density, 4° C. 
(39.2° F.), which will fill the cube of yo^o" P^^^ ^^ ^ meter ^ (cubic 
centimeter). 

The Metric is also known as the Decimal System, because its 
multiples and subdivisions are obtained by ten (Lat. decern). The 
prefixes denoting multiplication are of Greek derivation, and are 
usually spelled with a capital letter: Deka 10, Hecto 100, Kilo 
1000, Myria 10,000. Divisioii of the units is indicated by Latin pre- 
fixes, not capitalized : deci ^, centi y^-Q, milli yoVo"- ^^ distinguish 
readily one process from the other the word GILD has been aptly 
suggested as a mnemonic : 

GILD. 

Greek increases, Latin decreases. 

It may be observed that, strangely enough, while we still oppose 
the general adoption of the Metric System, our enumeration is 
decimal. We count from one to ten, and begin a new, yet similar, 
series of another ten units, and so on indefinitely,. We compute 
money in dollars, dimes, cents, and mills, decimally, and our record 
of time — years, decades, centuries — is in harmony with decimal 
arithmetic. 

Even the provision of the Federal Constitution declaring that a 
national census be taken every ten years is pertinent as a sugges- 
tion of decimal convenience ; and in the period prescribed for the 
State censuses, every five years, one-half of ten, there is no great 
deviation from the same principle of utility. 

Contrary to a prevalent opinion, the Metric System is easily 
mastered. A perfect acquaintance with the metric tables is, nat- 
urally, indispensable, and the abbreviations for the different weights 
and measures should be thoroughly at command. For the rest, 
the system is simply that of arithmetical decimals, requiring chiefly 
a correct use of the decimal point. Only a tyro would read .065 
six and five-tenths hundredths instead of sixty-five thousandths ; so 
Gm. .065 would never be read by one acquainted with decimals 

^ The unit of surface measure, the are, the square of ten meters, and the unit of the 
solid measure, the siere, having the capacity of a cubic meter, need not claim the atten- 
tion of the physician or the practical pharmacist. 



46 



A TEXT-BOOK OF MATERIA MEDICA. 



six centigrammes and five inilligrammeSy but sixty five 77iilli- 
grammes. 

Metric Table of Lengths. 



lO millimeters 
10 centimeters 
lo decimeters 
10 Meters 
lO Dekameters 
lO Hectometers 
lo Kilometers 



make 



I centimeter. 
I decimeter. 
I Meter. 
I Dekameter. 
I Hectometer. 
I Kilometer. 
I Myriameter. 



Abbreviations for the different divisions and multiples of the 
Meter are herewith given, together with their equivalents in inches, 
showing that the written system depends wholly upon the place 
of the decimal point, the figures remaining unchanged. It may be 
noted that the first abbreviations cited are. those commonly in use, 
although in certain cases the second are preferable : 

Metric Table of Linear Measure. 



millimeter is written I mm., or M .ooi, equal in inches to .039370432, approx. 



I centimeter 
I decimeter 
I Meter 
I Dekameter 
I Hectometer 
I Kilometer 
I Myriameter 



I cm., " M .01, 
I dm., " M .1, 
iM., " M I., 
I Dm., " M 10., 
I Hm., " M 100., 
I Km,, " M 1000., 
I Mm.," M loooo., 



.39370432, 
3-9370432, 
39-370432, 
393.70432 
3937.0432 
39370.432 
393704.32 



25- 
0.4. 

4- 
40. 



The term micromillimeter , one-thousandth of a millimeter 
(0.00000 1 ), is used, especially in microscopy, the abbreviations 
being mmm., mic, mkm., or the Greek letter fi. 

Metric Table of Capacities. 
10 milliliters make i centiliter. 



10 centiliters 
10 deciliters 
10 Liters 
10 Dekaliters 
10 Hectoliters 
10 Kiloliters 



I deciliter. 
I Liter. 
I Dekaliter. 
I Hectoliter. 
I Kiloliter. 
I Myrialiter. 



Abbreviations for the different divisions and multiples of the 
Liter, with their corresponding equivalents in minims or ounces, 
are as follows : 



WEIGHTS AND MEASURES. 



47 



I milliliter is written I 


Cc.i 


or L .ooi, 


equal in minims to 


16.23 


I centiliter " I 


cl. 


" L .oi, 


" 


(( 


162.3 


I deciliter " i 


dl. 


" L .1, 




" 


1623. 


I Liter " i 


L. 


" L I., 




fl. ounces 


33-814 


I Decaliter " I 


Dl. 


'' L lo., 




" 


338.14 


I Hectoliter " i 


HI. 


" L loo., 




" 


3381.4 


I Kiloliter " i 


Kl. 


" L looo 


, ** 


<< 


33814. 


I Myrialiter " i 


Ml. 


" L loooo., " 


" 


338140. 


Metric 


Table of 


Weights. 




10 milligrammes 




make 




I centig 


ramme. 


lo centigrammes 




<( 




I decigramme. 


lo decigrammes 




(( 




I Gramme. 


10 Grammes 




(( 




I Dekagramme. 


20 Dekagrammes 




n 




I Hecto 


gramme. 


lo Hectogrammes 


u 




I Kilogramme. 


lo Kilogrammes 




(< 




I Myriagramme. 



Abbi-eviations for the different divisions and multiples of the 
Gramme, with their corresponding equivalents in grains, are as 
follows : 



milligramme is written i mg., or Gm. .001, equal in grains to (g^^) 



I centigramme 


I eg., 


" Gm. 


.01, 


I decigramme 


" I dg., 


" Gm. 


.1, 


I Gramme 


I Gm., 


" Gm. 


I., 


I Dekagramme 


" I Dg., 


" Gm. 


10., 


I Hectogramme 


I Hg., 


" Gm. 


100., 


I Kilogramme 


" I Kg., 


" Gm. 


1000., 


I Myriagramme * 


' I Mg., 


" Gm. 


1 0000. 



.015432 
•15432 

15432 

15432 

154.32 
1543-2 
15432.3 
54323.4 



METHOD OF CONVERTING METRIC WEIGHTS, MEASURES, AND 
LENGTHS INTO THOSE IN COMMON USE, AND VICE VERSA. 
Approximate Table of Weights. 
I grain = 0.65 Gm. (65 milligrammes). 

I si grains = i. Gm. 

I drachm = 3.9 Gm. 

I troy ounce = 31.1 Gm, 

Approximate Table of Capacities. 

I minim = .06 Cc. 

16 minims = i. Cc. 

I fluidrachm = 3.75 Cc. 

I fluidounce = 30. Cc. 

* This is designated by Cc. instead of Ml, and in practice only cubic centimeters and 
Liters are employed. 



4^ A TEXT-BOOK OF MA TERIA MEDICA. 

Approximate Table of Lengths. 

I inch = .025 M. (25 millimeters). 
40 inches =1. M. 

Weights. 

To Convert Grains into the Correspo7iding Metric Equivalents. — 
It has been seen that i grain is equal to Gm. .065. In order, then, 
to convert grains or fractions of a grain into the corresponding 
metric quantity, we have simply to multiply the number of grains 
by .065. 



2 grains 


= 2 


X 


.065, or .130 


Gm. 


60 grains 


= 60 


X 


•065, '' 3-9 


Gm. 


\ grain 


= \ 


of 


.065, *' .0325, 


Gm. 


TFo g^am 


100 


of 


.065, ** .00065 


Gm. 



.065, or 2 


grains 


.065, " 60 


grains 


.065, - .5 


grain. 


.065, '' .01 


grain. 



etc. 

To Convert Metric Quantities into their Equivalent in Grains. — 
Instead of multiplying as above, divide, using the same number, 
.065, as a divisor. 

Gm. .130 = .130 

Gm. 3.9 = 3.9 

Gm. .0325 = .0325 

Gm. .00065 = .00065 

It follows that to convert Apothecaries' drachms into Grammes 
we multiply the number of drachms by 3.9, the number of Grammes 
in I drachm ; and to convert Grammes into Apothecaries' drachms 
we divide the number of Grammes by 3.9. 

The same rule applies to the conversion of Apothecaries' ounces 
into Grammes and Grammes into ounces, the multiplier and divisor 
being 31.1, the number of Grammes in i ounce. 

Volumes. 

To convert minims into the corresponding metric equivalents, 
multiply the number or fractions of minims by .06, this being the 
equivalent in Cc. of i minim ; and to convert the metric quantities 
into the corresponding equivalents in minims, divide the metric 
quantity by .06. To convert fluidrachms into Cc, midtiply the 
number of drachms by 3.75, the number of Cc. in i fluidrachm ; 
and to convert Cc. into fluidrachms, divide the number of Cc. by 
3.75. To convert fluidounces into Cc, midtiply the number of 
ounces by 30. Cc., the equivalent of i fluidounce ; and to convert 
Cc. into fluidounces, divide the number of Cc. by 30. 



WEIGHTS AND MEASURES. 



49 



For convenience of ready reference and to facilitate computa- 
tion the following tables are subjoined: 



Table of Metric Equivalents 

of Grains, Drachms, Minims, and Fluidrachms. 



3 


Grains. 


Milligrams, 
mg. 


Centigrams, 
eg. 


Decigrams, 
dcg. 


Grammes, 
Gm. 


Minims. 


Cubic centi- 
meters, Cc . 


I 




T0¥ 


0.65 


0.065 


0.0065 


0.00065 










tV 


0.85 


0.085 


0.0085 


0.00085 










-h 


I. 


O.I 


O.OI 


O.OOI 










3V 


1-3 


0.13 


0.013 


0.0013 










-h 


2.5 


0.25 


0.025 


0.0025 












6.5 


0.65 


0.065 


0.0065 










V' 


13. 


1.3 


0.13 


0.013 










i 


16. 


1.6 


0.16 


0.016 










1 


32. 


3-2 


0.32 


0.032 










I 


65. 


6.5 


0.65 


0.065 


I 


0.06 






2 




13- 


1-3 


0.13 


2 


0.12 






3 




20, 


2. 


0.2 


3 


0.18 






4 




25- 


2.5 


0.25 


4 


0.24 






5 




30- 


3- 


03 


5 


03 






7i 




50- 


5- 


0.5 


8 


0.5 






lO 




65. 


6.5 


0.65 


10 


0.6 






15 




100. 


10. 


I. 


16 


I. 






20 






13- 


1-3 


20 


125 






30 






20. 


2. 


32 


2. 




Z) 


60 






40. 


4. 


60 


3-75 


f^j 




100 






65. 


6.5 


100 


6. 




3U 


120 






80. 


8. 


120 


7-5 


fSiJ 




150 






100. 


10. 


150 


9- 




3"J 


1 80 
200 








12. 
13. 


i8o 
200 


11.25 
12. 


f^iij 


5iv 


240 








16. 


240 


15. 


f^iv 


5v 


300 








20. 


300 


18. 


fkv 


3vj 


360 
400 








24. 
26. 


360 
400 


22.5 
24. 


f^vj 


3vij 


420 








28. 
30- 


420 
450 


26.25 
27. 


f^vij 


l\ 


480 








32. 


480 


30- 


fjj 



Equivalents. 

Various methods have been proposed for adapting the metric 
weights to our apothecaries' weights used in prescription writing 
without entailing calculations in fractions. The method of taking 
32 Grammes as equivalent to one troy ounce, and 30 Cc, or fluid 
Grammes, as equal to one fluidounce, seems to be the least objec- 
tionable. These equivalents are shown in the following : 



32 Gm. 


= I ounce ; 


z^- 


-8 = 4. Gm. = I drachm. 


30 Cc. 


= I fluidounce 


30- 


- 8 = 3.75 Cc. =1 fluidrachm 



The exact metric equivalent of i grain is obtained by dividing 
the unit by the Gramme equivalent in grains; thus, i. -^ 15.432 = 
0.0648 Gramme (or 6\ centigrammes). 



50 



A TEXT-BOOK OF MATERIA MEDICA. 



The metric equivalents of all the other denominations may be 
obtained by multiplying the grain equivalent by the number of 
grains in one drachm ; the number of drachms in a troy ounce, etc. 
The following exact Gramme equivalents are thus obtained : 

I grain. i drachm. I ounce av. i ounce troy. i lb troy. i R) av. 

0.0648 3.888 28.349 31-103 373-250 453-592 

To convert avoirdupois or troy into metric weights, the equiva- 
lent of the Gramme in grains — 1 5.432 — should be remembered, as it 
serves the purpose of a basis for obtaining the equivalent of all the 
higher denominations. 

Table of Metric Equivalents 

of Ounces (Apoth., Av., and Fluid) in Grammes and Cubic Centimeters. 



Ounces, 


^ 


Grs. 


Grammes, 


Fluidounces, 


Cubic centimeters. 


Exact 


Apoth., 


Gm. or G. 


f^ 


Cm. or Cc. 


equivalents. 




I 




31 


I 


30 


29-57 




2 




62 


2 


60 


59-15 




3 




93 


3 ^ 


90 


88.72 




3 


103 


100 


3-38 


100 






4 




124 


4 


120 


118.3 




5 




155 


5 


150 


147.87 




6 




186 


6 


180 


177-44 




7 




217 


7 


210 


207.01 




8 




248 


8 


240 


236.59 




8 


18 


250 


8.45 


250 






9 




280 


9 


270 


266.16 




10 




3" 


10 


300 


295-73 




II 




342 


II 


330 


325-31 


iR) 


12 




373 


12 

I pt. 16 

17 tV 


360 

480 

500 


354-88 
473-18 


Av. 


Ounces. 


Grs. 


453-6 


iR) 


16 








17 


278 


500. 


20 


600 


591-47 




20 




566.8 


24 


720 


709.77 




24 




680. 


2pt. 32 


960 


946.35 




28 




793-2 


34 A 


1000 




2R) 


32 




907-25 


3Pt- 48 


1440 


1419. 




35 


120 


1000. 


4 pt. 64 


1920 


1892.71 


3R) 


48 




1360, 


68 A 


2000 




4ib 


64 




1814.5 


5 pt- 80 


2400 


2365.9 




70 


240 


2000. 


100 


3000 


2957-37 


5R) 


80 
100 




2268 
2835 


I gal. 128 


3840 


3785-43 


10 ft) 


160 




4536 









It will be noted that in the Pharmacopoeia of 1 890 the Gramme 
(Gm.) and the Cubic Centimeter (Cc.) are the only metrical terms 
used. The reason of this is simply that these two terms express 
sufficiently the quantities ordinarily handled, the remaining ones 
being excluded to avoid confusion, Grammes and Cubic Centi- 
meters standing as perfect equivalents of ordinary weights and 
measures, as the foregoing tables indicate. 



PHARMACEUTICAL PREPARATIONS. 51 



PHARMACEUTICAL PREPARATIONS. 

Preparations made by the pharmacist are cdlX^d pharmacezitical 
preparations. Nearly one-half of the articles of the United States 
Pharmacopoeia are pharmaceutical ; formulas being given for their 
preparation, they are intended to be made in the pharmacy. A 
still greater number are unofficial, being chiefly such as are made 
according to the formulas or prescriptions of eminent medical 
practitioners and teachers. Such of the latter as have attained 
general use and proved of value have been incorporated in the 
National Formulary, a work pubHshed under the direction of the 
American Pharmaceutical Association. 

The importance of having a uniform standard for the prepara- 
tion and strength of this class of medicines has long been recog- 
nized, instead of the variation in strength and product inseparable 
from a number of manufactures with the consequent multipHcity in 
processes and formulas. These preparations of the National For- 
mulary, designated N. F., are included in this work, following the 
official preparations (U. S. P.) of the classes to which they belong. 

The pharmaceutical preparations may be divided as follows : 

I. Solutions. 

II. Liquid Mixtures — Internal. 

III. Extractive Preparations — Liquid and Solid. 

IV. Mixtures of Solids — Internal. 

V. Mixtures for External Use — Liquids and Solids. 

These groups are each divided into a number of Classes, each 
-class having a distinct Latin title by which its members, or indi- 
vidual preparations, are officially designated and alphabetically 
arranged in the U. S. P. In addition to the Latin and English 
titles, each class is also known by an English name, besides various 
synonyms. There are altogether 34 of these Classes official, 
besides a number unofficial. Official 

number. 

I. The Solutions are divided, according to the charac- 
ter of the solvent, into — 

AqiieoiLS : Aquae — Waters . 19 

Liquores — Liquors (solutions proper) 24 

Alcoholic: Spiritus — Spirits 25 

Elixiria — Elixirs 2 

Vina — Wines (by solution) 3 



52 A TEXT-BOOK OF MATERIA MEDICA. 

Official number. 

Saccharine: Syrupi — Syrups 32 

Mellita — Honeys 2 

Glycerin : Glycerita — Glycerites 6 

II. The Liquid Mixtures — Internal : 

Misturae — Mixtures (proper) 4 

Emulsa — Emulsions 4 

III. Extractive Preparations : 

Liquid : 

Aqueous : Mucilagines — Mucilages 4 

Infusa — Infusions 4 

Decocta — Decoctions 2 

Acetous : Aceta — Vinegars 2 

Vinous: Vina — Wines 5, 

Alcoholic: Tincturse — Tinctures 71 

Extracta Fluida — Fluid Extracts 89 

Solid : 

Alcoholic: Extracta — Extracts ........ 33, 

Abstracts (unofficial). 

Resinse — Resins 3 

Semi-liquid : 

Ethereal: Oleoresinae — Oleoresins 6 

IV. Mixtures of Solids — Internal : 

Pulveres — Powders 9. 

Tritu ratio — Trituration I 

Sales effervescentes — Salts, effervescent .... 4 

Confectiones — Confections 2 

Trochisci — -Troches 15 

Massae — Masses 3. 

Pilule— Pills . 15 

V. Mixtures of SoHds — External : 

Liquid : Linimenta — Liniments ,9 

Oleata — Oleates 3 

Collodia — Collodions 4 

Solid: Unguenta — Ointments .......... 23 

Cerata — Cerates 6 

Suppositoria — Suppositories i 

Emplastra — Plasters 13 

Chartae — Papers . 2 

Total 453 



PHARMACEUTICAL PREPARATIONS. 53 

AQU^ MEDICATE— MEDICATED WATERS. 

The Medicated Waters are solutions of volatile substances in 
Water. They comprise (i) the Aromatic Waters and (2) the 
Chemical Waters. 

The Aromatic Waters are made by dissolving the volatile oils 
of their respective drugs, or distilling the latter with Water ; two 
Waters are saturated solutions of other liquids than volatile oils — 
viz. Aqua Chloroformi and Aqua Creosoti. 

The following are official : 

Contains Cc. in 100 Cc.^ 
Aqua — or percentage by voluf?ie. 

Amygdalae Amarae bitter almond oil o.l 

Anisi anise oil 0.2 

Aurantii Florum Fortior saturated 

Aurantii Florum of the above 50. 

Camphorae camphor 0.8 

Chloroform!^ chloroform 0.5 

Cinnamomi cinnamon oil 0.2 

Creosoti creosote i. 

Fceniculi fennel oil 0.2 

Menthae Piperitae peppermint oil 0.2 

Menthae Viridis spearmint oil 0.2 

Rosae Fortior saturated 

Rosae of the above 50. 

The Chemical Waters are solutions of gases in Water. The fol- 
lowing are official : 

Contains gas, percent- 
Aqua — age by weight. 

Ammoniae NH3 10 

Ammoniae Fortior NH3 28 

Chlori CI 0.4 

Hydrogenii Dioxidi (Hydrogen Peroxide) . . . H2O2 3. 

LIQUORES— SOLUTIONS. 

The Solutions (also termed Solutio, -nes, Lat.) are solutions of 
non-volatile substances in Water. 

The official Solutions are all solutions of inorganic salts. They 
are made either by simple solution (dissolving the particular salt in 

^ Chloroform Water, aside from its medicinal properties, is an efficient preservative 
agent, and forms a good solvent in place of w^ater for preparing solutions intended to be 
kept free from micro-organisms, as, for example, those for hypodermic use. 



54 A TEXT-BOOK OF MATERIA MEDICA. 

Water) or by chemical solution (reacting upon different substances, 
and obtaining the newly-formed salt in solution in the Water). The 
following 24 are official : 

The Arsenic Solutions : these are all of the same strength — 
viz. I per cent. ; 10 minims (0,6 Cc.) represent -^ grain (0.006 Gm.) 
of arsenic, the usual dose : 

Percentage 
Liquor — or Gm. in 100 Cc. 

Acidi Arsenosi acid, arsenous i. 

Arseni et Hydrargyri lodidi arsenic iodide i. 

(Donovan's Solution). mercuric iodide i. 

Potassii Arsenitis . . . potas. bicarb. 2; acid, arsenous i. 

(Fowler's Solution) tinct. lavender comp. 3. 

Sodii Arsenatis sodium arsenate i. 

The Alkali7te Salt Solutions, prepared by saturating an organic 
acid with an alkahne carbonate or bicarbonate, furnishing an agree- 
able and refreshing potion (also designated Saturatio, Potio, Lat.) 
charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- 
drachms (8-15 Cc), except Liq. Magnesiae Citratis : 

Liquor — Gm, in 100 Cc. 

Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. 

acid, acetic, dil. 100. 

Ferri et Ammonii Acetatis . . . Hquor ammon. acet 20. 

(Basham's Mixture), acid, acetic, dil. 3. ; tr. ferri chlor. 2. 

elix. arom. 12; glycerin 10; aqua ad 100. 

Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 30. 

potas. bicarb. 25.; syrup, 

acid, citric. 60 Cc; aqua ad 350. 

Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. 

acid, citric. 6.; aqua ad 100. 

The Iron Solutions, containing ferric salts in the following pro- 
portions by weight : 

Gm. in loOy or 
Liquor— percentage by weight. 

Ferri Acetatis ferric acetate 31. 

Ferri Chloridi . ferric chloride 37.8 

Ferri Citratis . . ferric citrate 42.5 

Ferri Nitratis ferric nitrate 6.2 

Ferri Subsulphatis (Monsel's) . . ferric subsulphate 43.7 

Ferri Tersulphatis ferric sulphate 28.7 



PHARMACEUTICAL PREPARATIONS. 55 

These are mostly used in producing other Iron preparations and 
compounds, particularly the Tincture of Ferric Chloride, the Ferric 
Hydrate (arsenical antidote), and the scaled salts of iron. 

The Alkali Solutions : 

Percentage by vol. 
Liquor — or weight. 

Calcis (Lime Water) calcium hydrate O.17 

Potassse potassium hydrate 5. 

Sodae sodium hydrate 5. 

Sodae Chloratae (Labarraque's) chlorine 2.6 

Lime Water is given as an antacid (10-30 Cc); Labarraque's 
Solution is used as a powerful disinfectant. 

The Solutions of Metallic Compounds ; all but that of Iodine 
are used only externally : 

Percentage by vol. 
Liquor — or weight. 

lodi Compositus (Lugol's Solution) . . potass, iodid. 10. 

iodine 5. 

Hydrargyri Nitratis mercuric nitrate 60. 

Plumbi Subacetatis lead subacetate 25. 

Plumbi Subacetatis Dilutus .... of above solution 3. 

(Lead Water) distilled water to 100. 

Sodii Silicatis sodium siHcate 50. 

Zinci Chloridi zinc chloride 50. 

The dose of Liq. lodi Comp. is 3-10 minims (0.2-0.6 Cc), 
preferably given in a little milk. 

Unofficial Liquors of the National Formulary. 
Liquor — 

AciDi Phosphorici Compositus (Acid Phosphates). 
Alumini Acetatis (Alumini Acetici, Ph. Gen). — Contains 8 

per cent, of basic Aluminum Acetate. 
Alumini Acetico-tartratis. — Contains about 50 per cent. 

of dry, so-called Aluminum Acetico-tartrate, which may 

be obtained by evaporating the solution. 
AuRi ET Arseni Bromidi. — Ten minims contain -3^2" gi'ain 

(0.002 Gm.) of Tribromide of Gold and ^ grain (0.004 Gm). 

of Tribromide of Arsenic. 
Bismuthi. — Each fluidrachm (4 Cc.) represents i grain (0.06 

Gm.) Bismuth and Ammonium Citrate. 
Bromi (Smith's Solution of Bromine). — Bromine, 20 per cent; 

Potassium Bromide, 10 per cent; Water. 



56 A TEXT- BOOK OF MATERIA MEDIC A. 

Liquor — 

Calcis Sulphurate (Solution of Oxysulphuret of Calcium ; 

Vleminck's Solution or Lotion). 
CuPRi Alkalinus (Fehling's Solution). 

I. The Copper Solution. 

Copper Sulphate, pure grains 505 . . 34,639 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 
II. The Alkaline Solution. 

Potassium and Sodium Tartrate . . grains 252 . . 173 Gm. 

Soda (U. S. P.) troy ounces 2 . , 60 Gm. 

Distilled Water . . enough to make fluidounces 16 . . 500 Cc. 

Keep both solutions, separately, in small well-stoppered vials, in a cool and 
dark place. For use, mix exactly equal volumes of both solutions by pouring 
the copper solution into the alkaline solution. Ten Cc. of the mixture prepared 
by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- 
ture prepared by apothecaries' weight and measure, 210 minims correspond to 
I grain of glucose. 

Electropoeicus (Battery-fluid). 

A. For the Carbon and Zinc Battery. — I. (For ordinary use). — Potassium Bi- 
chromate, in powder, 6 troy ounces (180 Gm.) ; Sulphuric Acid, commercial, 
6 fluidounces (180 Cc.) ; Water, cold, 48 fluidounces (1400 Cc). — II. (For use 
with the galvano- cautery). — Sodium Bichromate, in powder, 6j4, troy ounces 
(185 Gm.) ; Sulphuric Acid, commercial, 14 fluidounces (420 Cc); Water, 
cold, 48 fluidounces (1400 Cc). 

Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- 
ture occasionally during one hour. Then slowly add the Water. Sodium Bi- 
chromate is more soluble than the Potassium Salt, and also much cheaper. 
When it cannot be obtained, the Potassium Salt may be substituted for it, 
weight for weight. 

B. For the Leclanche Battery. — Ammonium Chloride, 6 troy ounces (180 
Gm.) ; Water, enough to make 20 fluidounces (600 Cc.) ; dissolve the Salt in 
-the Water. 

Ferri Oxysulphatis (Oxy sulphate of Iron). 

Ferri Protochloridi (Solution of Ferrous Chloride). — Each 
fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of 
Protochloride of Iron (ferrous chloride). 

Hydrargyri et Potassii Iodidi (Solution of Iodide of Mer- 
cury and Potassium ; Channing's Solution). — Red Mercuric 
Iodide, 72 grains (5.0 Gm.) ; Potassium Iodide, 56 grains 
(3.8 Gm.); in Distilled Water, 16 fluidounces (450 Cc). 

Hypophosphitum. — Each fluidrachm (4 Cc.) contains 2 grains 
(0.12 Gm.) of Calcium Hypophosphite, \\ grains (0.75 Gm.) 
of Sodium Hypophosphite, and i grain (0.06 Gm.) of Po- 
tassium Hypophosphite. 

loDi Carbolatus (Boulton's Solution ; " French Mixture ").— 



PHARMACEUTICAL PREPARATIONS. . S7 

X.iquor — 

Comp. Tincture of Iodine, no minims (7 Cc.) ; Carbolic 
Acid, 40 grains (3.0 Gm.) ; Glycerin, 2\ fluidounces (lOO.O 
Cc.) ; in 16 fluidounces (450 Cc). 

loDi Causticus (Iodine Caustic ; Churchill's Iodine Caustic). 
— Iodine, I troy ounce (31 Gm ) ; Potassium Iodide, 2 troy 
ounces (63 Gm.) ; in Water, 4 fluidounces (120 Cc). 

Magnesii Bromidi. — Each fluidounce (30 Cc.) contains about 
7 grains (0.5 Gm.) of Magnesium Bromide. 

Morphine Citratis. — Each fluidrachm (4 Cc) contains 2 
grains (0.12 Gm.) of Morphine in the form of citrate. 

MoRPHiN.E Hypodermicus (Magcndic's Solution of Morphine). 
— 1 6 grains ( I Gm.) Morphine Sulphate to i fluidounce (30 Cc). 

Pancreaticus (Pancreatic Solution). — Each fluidrachm (4 Cc) 
represents i grain (0.06 Gm.) of Pancreatin, effectually pre- 
served in Glycerin and a little Alcohol. 

Pepsini Aromaticus. — Each fluidrachm (4 Cc) represents 
I grain (0.06 Gm.) of Pepsin. 

Phosphori (Thompson's Solution of Phosphorus). — Each fluid- 
drachm (4 Cc.) contains about -^ grain (0.0025 Gm.) of 
Phosphorus, preserved in Absolute Altohol and Glycerin. 

Picis Alkalinus (Tar, Alkaline). 

PoTASSiE Chlorat.e (Solution of Chlorinated Potassa ; Javelle 
Water). — An effective and popular disinfectant. 

PoTASSii Arsenatis et Bromidi (Liquor Arsenii Bromidi ; 
Clemens' Solution). — This solution contains an amount of 
Arsenic in combination corresponding to about i per cent, 
of Arsenous Acid. 

The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which 
is often applied to Clemens' Solution or similar preparation, is a misnomer, 
since bromide of arsenic cannot exist, as such, in presence of water, but is 
split up into hydrobromic and arsenous acids. The proportions of the ingre- 
dients, in the formula above given, have been adjusted as closely as practicable, 
so as to yield definite compounds — viz. arsenate and bromide of potassium. 

Saccharini (Solution of Saccharin). — Each fluidrachm repre- 
sents 4 grains of Saccharin. 

Intended to be used for sweetening liquids and solids when the use 
of sugar is objectionable, or when a sweet taste is to be imparted to a liquid 
without increasing its density. 

1 Particular care sliould be taken in prescribing and dispensing this solution, so that 
it may not be mistaken for the so-called United States Solution of Morphine (Liquor 
Morphise Sulphatis, U. S. P. 1870), containing only I grain of Sulphate of Morphine 
in each fluidounce, which is still occasionally used. 



58 A TEXT-BOOK OF MA TERIA MEDICA. 

Liquor — 

Se-riparus (Liquid Rennet). 

If this liquid is to be used merely for curdling milk, without separating the 
whey as a distinct layer, it should be added to the milk, previously warmed 
to a temperature of about 35° C. (95° F.), and the mixture should then be set 
aside undisturbed until it coagulates. If the whey is to be separated, the 
Liquid Rennet should be added to the milk while cold, and the mixture 
heated to about 35° C. (95° F.), but not exceeding 40° C. (104° F.). One part 
of the liquid should coagulate between 200 and 300 parts of cows' milk. 

Liquor Sodii Arsenatis, Pearson. — This Solution contains 
about yig- per cent, of anhydrous Sodium Arsenate. 

This preparation should not be confounded with the Liquor Sodii Arsenatis 
of the U^. S. P., which is ten times stronger than the above. Pearson's Solu- 
tion is official in the French Pharmacopoeia, under the title Solute d'Arse- 
niate de Soude (or Solution Arsenicale de Pearson). 

Sodii Boratis Compositus (Dobell's Solution). — Sodium 
Borate and Sodium Bicarbonate, each 120 grains (8.0 Gm.); 
Carbolic Acid, 24 grains (1.5 Gm.) ; Glycerin,-!- fluidounce 
(15 Cc.) ; in Water, 16 fluidounces (450 Cc). 

Sodii Carbolatis (Phenol Sodique). — CarboHc Acid, 50 per 
cent; Soda, 3 per cent; in Water. 

Sodii Citratis. — Saturatio (Potio Riveri, Ph. Ger.). — Citric 
Acid, 150 grains (lO.o Gm.) ; Sodium Bicarbonate, 190 
grains (12.5 Gm.) ; in Water, 16 fluidounces (450 Cc). 

Sodii Citro-tartratis (Effervescing Saline Water). — Sodium 
Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, 
in about the same proportions as in Solution of Magnesium 
Citrate, for which it is a cheaper substitute. 

Sodii Oleatis (Oleate of Sodium). — Intended to be used in 
the preparation of oleates. 

Strychnine Acetatis (Hall's Solution of Strychnine). — Each 
fluidrachm (4 Cc.) contains \ grain (0.008 Gm.) Strychnine 
Acetate. 

The Ph. Br. directs a Liquor Strychninse Hydrochloratis (with synonym. 
Liquor Strychnise) which is much stronger, and should not be confounded 
with the above preparation. It should never be dispensed unless expressly 
designated. 

ZiNci ET Ferri Compositus (Deodorant Solution). — A com- 
bination of Sulphates of Zinc and Iron, Naphthol, Oil of 
Thyme, and Hypophosphorous Acid, in Water. 

Used as a simple deodorant and antiseptic for common domestic use when 
it is unnecessary or impracticable to employ more powerful agents. 



PHARMACEUTICAL PREPARATIONS, 59 

When a deodorant solution is required for purposes where iron is objection- 
able — as, for instance, when woven fabrics are to be steeped in it— the follow- 
ing preparation may be employed : 

Liquo7' Zinci et Ahimini Co??ipositus, in which the Iron Sulphate is replaced 
by Aluminum Sulphate. 

Liquor — 

ZiNGiBERis (Essence of Ginger). — A 25 per cent, preparation 
of Ginger for flavoring aqueous mixtures. 

SPIRITUS— SPIRITS. 

The Spirits are solutions of volatile substances in Alcohol. 
They comprise (i) the Natural Spirits; (2) the Aromatic Spirits, 
or so-called " Essences ; " and (3) the Medicinal Spirits. 

The Natural Spirits are produced by distillation, and include : 

Spiritus Frumenti (Whiskey), containing Alcohol 50-58 per 

cent, by volume. 
Spiritus Vini Gallici (Brandy), containing Alcohol 46-55 per 

cent, by volume. 
Spiritus Juniperi Comp. (Gin), containing Alcohol 60-70 per 

cent, by volume. 

The Aromatic Spirits are made by dissolving the respective oils 
or aromatic principles in (deodorized) Alcohol : 

Cc. in 100 Cc, 
Spiritus — or percentage by vol. 

Amygdalae Amarae (water 20) . . bitter almond oil i. 

Anisi (alcohol deod.) anise oil 10. 

Aurantii " " orange oil 5. 

Aurantii Comp. (alcohol deod.) .... orange oil 20. 

oils, anise 0.5, coriander 2; lemon oil 5. 

Camphorae camphor 10. 

Cinnamomi cinnamon oil 10. 

Gaultheriae wintergreen oil 5. 

Juniperi juniper oil 5. 

Lavandulae (alcohol deod.) lavender oil 5. 

Limonis lemon peel 5 ; oil 5. 

Menthae Piperitae peppermint herb i ; oil 10. 

Menthae Viridis . . . • . . spearmint herb i ; oil 10. 

Myrciae (Bay Rum) ... . . water 38; oil of bay 0.8 

oils, orange, pimenta, each 0.05 

Myristicae nutmeg (vol.) oil 5. 

These are chiefly used for flavoring purposes ; some are used 



6o A TEXT-BOOK OF MATERIA MEDICA. 

medicinally as aromatic stimulants and carminatives in doses of 
from 15-30 minims (1-2 Cc.) ; Spiritus Amygdalae Amarae con- 
tains Hydrocyanic Acid, and is never used internally except in 
very small quantities as a flavor. 

The Medicinal Spirits are made by solutions of the medicinal 
substance in Alcohol. 

The following are official : ^ . ^ 

^ Cc. in 100 Cc, 

Spiritus — or percentage by vol. 

^theris ether (€21^5)20 32.5 

^theris Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 

ether 32.5 

By weight. 

y^theris Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. 

Ammoniae ammonia gas 10. 

Ammoniae Aromaticus . . water 14; ammonia water 9. 

ammonia carb. 3.4 

oils, lavender, nutmeg, each 0.1 ; lemon oil i. 

Chloroformi chloroform 6. 

Glonoini nitroglycerin i. 

Phosphori absolute alcohol, phosphorus 0.12 

The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc. ; 
about 75 to 150 "drops"), except the Ammonia Spirit, used only in 
the preparation of Liniments (externally), and that of Phosphorus, 
which is for the preparation of the Elixir. 

Unofficial Spirits of the National Formulary. 
Spiritus — 

AciDi FoRMici (Spirit of Ants, Ph. Ger.). — A solution of 
3 per cent, of Formic Acid in Water and Alcohol. 

Ophthalmicus (Alcoholic Eye-wash). — A solution of 10 min- 
ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil 
of Rosemary, in Alcohol i fluidounce (30 Cc). 

Saponatus (Spirit of Soap). 

SiNAPis (Spirit of Mustard, Ph. Ger.). — A solution of 2\ per 
cent, of Volatile Oil of Mustard in Alcohol. 

SYRUPI— SYRUPS. 

Syrups are nearly saturated Solutions of Sugar in Water, in 
which aromatic or medicinal substances are dissolved. 

The official Syrup, Syrupus, contains 65 per cent, by weight, 
85 per cent, by volume, of Sugar (about 7 pounds, average, in 



PHARMACEUTICAL PREPARATIONS. 6l 

I gallon) : with a smaller proportion of Sugar the syrup undergoes 
fermentation (spoils). 

The " Medicated Syrups " contain less sugar, owing to the solu- 
tion of the medicinal substances, which usually reduce the solubility 
of the sugar in the liquid from which the syrup is prepared. 
Syrups should be kept in a cool place, in cork-stoppered bottles, in 
order to preserve them. 

The thirty-two official Syrups are made by different methods : 
by solution, or mixing the medicinal substance with the syrup ; 
by dissolving the Sugar in the medicinal solution ; by extraction 
from the drug ; and by chemical reaction and solution. 

They may be divided into (i) the aromatic or adjuvant syrups, 
and (2) the medicinal syrups, comprising (ci) those made from 
extractive drugs, including alteratives, astringents, cathartics, and 
expectorants, and (U) those made from chemicals, either by simple 
solution or by chemical reaction and solution, including the hypo- 
phosphites, iron, and other tonics. 

The Aromatic or Adjuvant Syrups are mostly used as additions 
to, or vehicles of, liquid mixtures containing Bromides, Iodides, 
Phosphates, or similar salts of disagreeable saline taste, desirable 
to disguise. 

The followincr are official : ^ . ^ 

° Lc. in 100 Cc, 

Syrupus — or percentage by vol. 

Acacise mucilage acacia 25. 

Acidi Citrici spir. lemon, I ; acid, citric I. 

Althaeae marshmallow 5. 

Amygdalae . . (bitter almond 4, sweet almond 14) 18. 

orange flower water 10. 

Aurantii orange, fresh exterior rind 5. 

Aurantii Florum orange flower water 50. 

Rubi Idaei raspberry juice (fresh) 40. 

Tolutanus tolu balsam i. 

Zingiberis fluid extract of ginger 3. 

The Extractive Syrups are often made by mixing the Fluid 
Extract of the respective drugs with Syrup. 

Tinctures and Fluid Extracts of resi^ious drugs often precipitate 
when mixed with Syrups and aqueous solutions. In order to fur- 
nish clear mixtures it is therefore sometimes necessary to mix the 
extractive preparation with Water, clarify the mixture by filtration, 
and dissolve the sugar in the filtered liquid. 



62 A TEXT-BOOK OF MA TERIA MEDIC A. 

The following are official : 

Gjh. of Drug 
Syrupus— ,-^ j^^ Cc 

Allii vinegar of garlic 20. 

Ipecacuanhae fl. ext. ipecac 7. 

Kramerise fl. ext. rhatany 45. 

Lactucarii tinct. lactucarium 10. 

Picis Liquidae glycerite, tar 7.5 

Pruni Virginianae wild cherry 15. 

Rhei fl. ext. rhubarb 10. 

Rhei Aromaticus tinct. rhubarb, arom. 15. 

Rosae fl. ext. red rose 12.5 

Rubi fl. ext. blackberry bark 25. 

Sarsaparillae Comp fl. ext. sarsaparilla 20. 

fl. ext. glycyrrh., senna, each 1.5 

oils, sassafras, anise, gaultheria, each 0.0 1 

Scillae vinegar of squill 45. 

Scillae Comp fl. exts. squill, senega, each 8. 

(Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 

Senegae fl. ext. senega 20. 

Sennae oil coriander 0.5 ; senna 25. 

The dose of the Syrups of Ipecac, Squill, Squill Comp., and 
Senega as an expectorant is from 5-30 minims (0.5-2 Cc); as 
emetic, from 1-2 fluidrachms (4-8 Cc). 

The Chemical Syrups are an elegant class of preparations in 
which the taste of the medicinal agents is greatly modified. They 
do not keep well unless put up in small bottles completely filled, 
ready for dispensing. Except the Syrup of Iodide of Iron, which 
is best preserved in bottles exposed to light, they should be kept 
in a cool and dark place. 

The dose is from i to 2 teaspoonfuls (4 to 8 Cc), except of the 
Syrup of Iodide of Iron, the ordinary dose of which is 10 drops, 
nearly equivalent to 10 minims (0.6 Cc). 

The Syrup of Iron, Quinine, and Strychnine Phosphates (Easton's 
Syrup, Ph. Br.) is almost identical with the well-known unofficial 
Elixir of that name. It contains -^ grain of Strychnine in 80 min- 
ims (i mg. in 5 Cc) ; the formula of the U. S. P. 1880 yielding a 
Syrup nearly three times as strong, care should be bbserved that 
the preparations of the two formulas be not accidentally confused 
with each other. A somewhat similar preparation is the Syrupus 
Hypophosphitum Compositus of the N. F. 



PHARMACEUTICAL PREPARATIONS. 63 

The following are official: Percentage, 

Gm. or Cc. 
Syrupus — in 100. 

Acidi Hydriodici acid, hydriodic, by weight I. 

Calcii. Lactophosphat's . . . calcium lactophosphate i. 

Calcis lime (calcium saccharate) i. 

Ferri lodidi ferrous iodide, by weight 10. 

Grains Percent- 
iti I Jiuid- age by 
drachm (^ CV.). vol. 

Ferri, Quininae et Stiychninae Phosphatum: 

ferric phosphate, soluble i\ 2. 

quinine sulphate 2 3. 

strychnine -g^Q- 0.02 

acid, phosphoric 3 4.8 

Hypophosphitum . . . calcium hypophosphite 3 4.5 

potassium and sodium hypophosphites, each I 1. 5 

spirit lemon 0.5 ; acid hypophos. dil. 0.2 

Hypophosphitum cum Ferro . . ferrous lactate I. 

with potass, citrate i, in syrup hypophosph. 

Unofficial Syrups of the Natiojial Formulary. 

Unless otherwise stated, the dose is i to 2 fluidrachms or tea- 
spoonfuls (4-8 Cc). 
Syrupus — 

AcT^^ CoMPOsiTUS (Cimicifuga or Black Cohosh). — Contain- 
ing 2-|- grains (0.15) each of Cimicifuga and Wild Cherry, 
i:^ grains (0.07) Glycyrrhiza and Senega, and -| grain (0.04) 
Ipecac in each fluidrachm (4 Cc). 

AsARi CoMPOSiTUS (Canada Snake Root).- —Each fluidrachm 
(4 Cc.) represents 3-|- grains (0.2) of Asarum. 

Calcii Chlorhydrophosphatis (Chlorhydrophosphate of 
Lim.e). — Each fluidrachm (4 Cc) contains i grain (0.06) of 
Calcium Phosphate. 

Calcii et Sodii Hypophosphitum (Hypophosphite of Lime 
and Soda). — Each fluidrachm (4 Cc.) contains 2 grains (0.13), 
each, of Hypophosphites of Calcium and Sodium. 

Calcii Hypophosphitis (Hypophosphite of Lime). — Each 
fluidrachm (4 Cc) contains 2 grains (0.13) of Calcium Hypo- 
phosphite. 

Calcii Iodidi (Iodide of Calcium). — Each fluidrachm (4 Cc.) 
contains about 5 grains (0.3) of Calcium Iodide. 



64 A TEXT-BOOK OF MATERIA MEDIC A. 

Synipus — 

Calcii Lactophosphatis cum Ferro (Lactophosphate of 
Lime with Iron). — Each fluidrachm (4 Cc.) contains \ grain 
(0.03) of Lactate of Iron and about \ grain (0.015) of 
Calcium Lactate (or about f grain (0.02) of so-called Lacto- 
phosphate of Calcium). 

Chondri Compositus (Irish Moss). — Containing i grain (0.06) 
each of Squill and Senega, ^ grain (0.004) ^^ch of Ipecac 
and Irish Moss, and i|- minims (o.i) Tincture Opium Camph. 
to each fluidrachm (4 Cc). 

CiNNAMOMi (Cinnamon, Ph. Ger.). — Chiefly used for flavoring. 

Codeine. — Containing \ grain (0.03) Codeine Sulphate in 
each fluidrachm (4 Cc). The Syrup of the French Codex 
is about one-fourth this strength. 

CoFFEvE (Coffee). — Containing 15 grains (i.) of the choicest 
Coffee (Java and Mocha) in fluidrachm (4 Cc.) ; an elegant 
vehicle for Quinine and addition to nauseous mixtures. 

Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). 
— Chiefly intended as a vehicle for disguising the taste of 
Quinine and other bitter substances. 

Ferri Arsenatis. — Each fluidrachm (4 Cc.) contains about 
■gig- grain (0.00 1) of Arsenate of Iron (ferric). 

Ferri Bromidi (U. S. P., '80).— Containing 10 per cent, of 
Ferrous Bromide. 

Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron). — 
Each fluidrachm (4 Cc) contains an amount of Iron corre- 
sponding to about 3.6 grains (0.25) of Ferric Iodide. The 
official Syrupus Ferri lodidi contains about 8 grains (0.5) 
of Ferrous Iodide (Protiodide of Iron) in each fluidrachm 
(4 Cc). 

Ferri et Mangani Iodidi (Iodide of Iron and Manganese). — 
Each fluidrachm (4 Cc.) contains 6 grains (0.4) of Iodide 
of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. 

Ferri Hypophosphitis (Hypophosphite of Iron). — Each fluid- 
drachm (4 Cc) contains i grain (0.06) of Hypophosphite of 
Iron (ferric). 

Ferri Lactophosphatis (Lactophosphate of Iron). — Each 
fluidrachm (4 Cc.) contains i grain (0.06) of Lactate of 
Iron, or about i^ grains (o.i) of so-called Lactophosphate 
of Iron. 

Ferri Protochloridi (Ferrous Chloride). — Each fluidrachm 



PHARMACEUTICAL PREPARATIONS. 65 

Syrupus— 

(4 Cc.) contains about i grain (0.06) of Protochloride of 
Iron. 

Ferri Saccharati Solubilis (Soluble Saccharated Iron; 
Saccharated Oxide of Iron, Ph. Ger.). — Each 75 minims (5 
Cc.) represents approximately i grain (0.06) of Metallic 
Iron, or 3 grains (0.2) of Oxide of Iron. 

Glycyrrhiz^ (Liquorice). — Each fluidrachm (4 Cc.) repre- 
sents 30 grains (2.) of Glycyrrhiza. 

Hypophosphitum Compositus. — Each fluidrachm (4 Cc.) con- 
tains 2 grains (0.12) of Calcium Hypophosphite, I grain 
(0.06), each, of the Hypophosphites of Potassium and 
Sodium, \ grain (0.008), each, of the Hypophosphites of 
Iron and Manganese, ^ grain (0.004) of Quinine Hydro- 
chlorate, and i;^ minims (0.0 1) of Tincture of Nux Vomica. 

This Syrup should not be confounded with the official Syrupus Hypo- 
phosphitum (Syrup of the Hypophosphites : Calcium, Sodium, and Potassium). 
It is intended to replace a well-known proprietary article, for which it has been 
found by many physicians to be a satisfactory substitute. It is uniform in com- 
position and more stable and elegant than the patent article. 

Ipecacuanha, et Opii (Syrup of Dover's Powder). — Each 
fluidrachm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- 
der, or \ grain (0.03), each, of Ipecac and Opium. 

ManntE (Syrup of Manna, Ph. Ger.). 

MoRPHiNyE Compositus. — A preparation sometimes dispensed 
as Jackson's Pectoral Syrup, but, as it differs in essential 
particulars, the N. F. recommends that this preparation be 
dispensed only when expressly designated under this title. 
Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 
5 grains (0.3) Senega, i grain (0.06) Rhubarb, and -^ 
grain (0.002) Morphine, with Oil of Sassafras. 

Morphin.e: Sulphatis (Syrup of Morphine). — Each fluid- 
drachm (4 Cc.) contains \ grain (0.008) of Sulphate of 
Morphine. 

Papaveris (Poppy, Ph. Br. ; Diacodii, Ph. Ger.). — Similar to the 
preceding, but considerably weaker. 

Pectoralis (Jackson's Pectoral Syrup). — Each fluidrachm 
(4 Cc.) contains -^ grain (0.002), each, of Morphine and Oil 
of Sassafras. 

Phosphatum Compositus (Chemical Food). — Each fluidrachm 
(4 Cc.) contains about 2 grains (0.12) of Phosphate of 



66 A TEXT-BOOK OF MATERIA MEDIC A. 

Syrupus — 

Calcium, i grain (0.06), each, of the Phosphates of Iron 
and Ammonium, and smaller quantities of the Phosphates 
of Potassium and Sodium. 

PiNi Strobi CoMPOSiTus (White Pine Compound). — A com- 
bination of White Pine, Wild Cherry, Spikenard, San- 
guinaria, Chloroform, and Morphine, -^-^ grain (0.002) in a 
fluidrachm. 

Rhamni Cathartics (Buckthorn Berries; Syrupus Spinae 
Cervinae, Ph. Ger.). 

RuBi Aromaticus (Blackberry, Aromatic). — A combination 
of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. 

Sanguinaris (Bloodroot). — Each fluidrachm (4 Cc.) repre- 
sents 13 grains (0.8) of Sanguinaria. 

SENNiE Aromaticus (Senna, Aromatic). — Each fluidrachm 
(4 Cc.) represents 7} grains (0.5) of Senna, 3 grains (0.2) 
of Jalap, and i grain (0.06) of Rhubarb, with aromatics. 

Senns Compositus (Senna, Compound). — Each fluidrachm 
(4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), 
each, of Rhubarb and Frangula. 

SoDii Hypophosphitis. — Each fluidrachm (4 Cc.) contains 
2 grains (0.12) of Sodium Hypophosphite. 

Stillingis Compositus. — Each fluidrachm (4 Cc.) represents 
15 minims (i Cc.) of Compound Fluid Extract of Stillingia. 

OxYMEL SciLLS (Oxymel of Squill, Ph. Br.). — A preparation 
of Honey containing about 5 grains (.32 Gm.) of Squill in 
each fluidrachm (4 Cc). 

ELIXIRIA— ELIXIRS. 
Elixirs are a class of elegant preparations similar to wines or 
cordials, composed of Water, Sugar, Alcohol, and Aromatics. 

The medicinal substances are usually in such proportion that an 
ordinaiy dose may be contained in one or two teaspoonfuls (4 to 8 
Cc.) of the elixir. 

There are but two EHxirs official: Aromatic Elixir, which 
serves as a vehicle, and one medicinal. Elixir of Phosphorus. 

Elixir Aromaticum spirit of orange, comp. 12 Cc. 

mix with alcohol, deodorized, to make 250 Cc. 

to this solution add in several portions, agitating 

after each addition syrup 375 Cc. 

and in the same manner water 375 Cc. 



PHARMACEUTICAL PREPARATIONS. 6^ 

mix the liquid with precipitated calcium phosphate 15 Gm. 
and filter, adding . . water 3 ; alcohol I ; to make lOOO Cc. 

This illustrates the method by which Elixirs are made. The 
medicinal ingredients are dissolved in the Water, or Alcohol, as 
indicated by their solubilities, before mixing the Alcoholic Solution 
of Oils with the Saccharine Solution. 

Elixir Phosphori : glyc. 55 ; anise oil 0.2; sp. phosph. 21 Cc. 
mix by agitation ; then add . aromatic eHxir, to lOO Cc. 

This Elixir contains of phosphorus 25 mg. in 100 Cc, or -^ 
grain (i mg.) in i fluidrachm (4 Cc), the ordinary dose. 

Some Salts and Fluid Extracts may be dissolved in or mixed 
with the Elixir itself For example : 

Potassii Bromidi 10. 

Elixir Aromatici q. s. ad 100. Cc 

This contains 15 grains (i Gm.) in 2^ fluidrachms (10 Cc), 6 
grains in i fluidrachm or teaspoonful. 

Elixirs of the National Formulary. 
The value of pleasant vehicles to mask or modify the taste of 
bitter and nauseous drugs is recognized by every prescriber. The 
following Elixirs of the National Formulary have been carefully 
selected, and embrace the most effective combinations of adjuvants 
and aromatics for disguising the different drugs for which they are 
recommended : 
Elixir— 

Anisi; a combination of Anethol, Fennel, and Bitter Almond. 
CuRASSAO (Curagao Cordial); a combination of Curasao, Orris, 
and a little Citric Acid. 
Adjuvant Elixirs. — The following are intended as vehicles for 
Quinine and similar bitter substances, and as adjuvants for Tinctures 
and Fluid Extracts of bitter and resinous drugs, such as Cinchona, 
Cascara Sagrada, etc. They all contain Glycyrrhiza, which, in the 
form directed in the N. F. (Russian Licorice Root, peeled), is most 
effective in masking the bitter taste of Quinine, when it is directed to 
be simply suspended in the mixture without the use of acid for 
effecting solution. Acids precipitate the glycyrrhizin and destroy 
its power of masking the bitter taste : 
Elixir— 

Adjuvans ; a combination of Orange, Wild Cherry, Glycyr- 
rhiza, Coriander, and Caraway. 

Except for the exhibition of Quinine this is the most effective of the adju- 
vant Ehxirs. 



68 A TEXT- BOOK OF MATERIA MEDIC A. 

Elixir— 

Eriodictyi Aromaticum (Arom. Elixir Yerba Santa; Elixir 
Corrigens). — A solution of Yerba Santa in Comp. Elixir of 
Taraxacum, intended as a vehicle for Quinine and other 
bitter remedies. 

GLYCYRRHIZ.E (Elixir of Licorice) ; a solution of Licorice in 
Aromatic Elixir, the most effective vehicle for Quinine. 

Glycyrrhiz^ Aromaticum ; Elixir of Licorice, with the addi- 
tion of strong aromatics. 

Taraxaci Compositum ; an improved form of this well-known 
compound, useful as a mild adjuvant. 

Medicinal Elixirs.- — These comprise the Elixirs mostly in use ; 
also, a number of preparations in which the prescriber will find 
satisfactory substitutes, designated by scientific titles and of 
definite strength and uniform composition, intended to replace 
various nostrums. 

Active Drug in 

I Fluidrachm. 4 Cc. 
Elixir — grains. Gm. 

AciDi Salicylici 5 0.3 

Ammonii Bromidi 5 0.3 

Ammonii Valerianatis 2 0.12 

The odor and taste of the salt being well 
covered by the addition of vanilla and a 
little chloroform. 
Ammonii Valerianatis et QuinintE. — The 

above, with Quinine Hydrochlorate .... \ 0.0 1 5 
Apii Graveolentis (Celery Compound). — Con- 
taining Celery, Coca, Kola, and Viburnum, 

each . 4 0.25 

Bismuthi. — Bismuth and Ammonium Citrate . 2 0.12 

BucHu 7^ 0.5 

BucHu Compositum. — Buchu, Cubeb, Juniper, 

and Uva Ursi, combined 15 i- 

Buchu et Potassii Acetatis. — Elixir Buchu, 

with Potassium Acetate 5 0.3 

Caffeine. — Caffeine (in solution in Hydro- 

bromic Acid) I 0.06 

Calcii Bromidi 5 0.3 

Calcii Hypophosphitis 2 .12 



PHARMACEUTICAL PREPARATIONS. 69 

Active Drug in 

I Fluidrachm. 4 Cc. 
Elixir— Grains. Gm. 

Calcii Lactophosphatis. — Calcium Lactate (in 

Phosphoric Acid) I O.06 

Catharticum Compositum. — Each fluidrachm 
(4 Cc.) contains Senna y^ grains (0.5) ; Podo- 
phyllum 4 grains (0.25); Leptandra and 
Jalap, each 3 grains (0.2) ; Rochelle Salts 
7 J grains (0.5) ; and Sodium. Bicarbonate i 
grain (0.06). The mixture should be shaken. 

Chloroformi Compositum. — A mixture of 
equal parts of Chloroform, Tincture of 
Opium, Spirit of Camphor, Aromatic Spirit 
of Ammonia, and Alcohol, flavored with Cin- 
namon. The old title, *' Chloroform Pare- 
goric," is recommended to be abandoned for 
the above. Each fluidrachm (4 Cc.) contains 
I grain (0.06) of Opium and 1 1 minims (0.7) 
of Chloroform. 

Cinchona (Elixir CaHsaya). — This preparation 
is from the best Calisaya Bark, representing 
about 2 grains (0.12) in each fluidrachm (4 
Cc). It is preferable to preparations made 
from Quinine and the cheaper alkaloids in 
being a more agreeable and effective anti- 
periodic tonic. 

Cinchona et Ferri (Calisaya and Iron ; Fer- 

rated Elixir of Calisaya). — Phosphate of Iron . 2 0.12 

Cinchona et Hypophosphitum. — Calcium and 

Sodium Hypophosphites, each ...... i 0.06 

Cinchona, Ferri, Bismuthi et Strychnine. 

— Phosphate of Iron 2 0.12 

Bismuth and Ammonium Citrate I 0.06 

Strychnine Sulphate yi-g- 0.0007 

CiNCHON.E, Ferri et Bismuthi. — Phosphate of 

Iron 2 0.12 

Bismuth and Ammonium Citrate I 0.06 

Cinchona, Ferri et Calcii Lactophosphatis. 

— Phosphate of Iron ij o.i 

Calcium Lactophosphate about i 0.06 



yo A TEXT-BOOK OF MA TERIA MEDICA. 

Active Drug in 

I Fluidrachm. 4 Cc. 
Elixir — Grains. Gm. 

Cinchona, Ferri et Pepsini. — Phosphate of 

Iron li 0.1 

Pepsin I 0.06 

Cinchona, Ferri et Strychnine. — Phosphate 

of Iron 2 0.12 

Sulphate of Strychnine yi^ O.0007 

Cinchona, Pepsini et Strychnine. — Contain- 
ing smaller quantities of the Cinchona Alka- 
loids, Pepsin I grain (0.06), and Sulphate 

of Strychnine -^-^ 0.0007 

CociE (Coca). — Leaves, Erythroxylon Coca . . 72 0.5 
CocE ET GuARANE. — Coca and Guarana, of each 7 J 0.5 
CoRYDALis CoMPOSiTUM. — Containing of Cory- 
dalis, Stillingia, Iris, and Xanthoxylum, 

combined 15 i. 

Potassium Iodide 3 0.2 

DiGESTivuM CoMPOSiTUM. — Containing about 5 
grains (0.3) of Pulvis Digestivus in each 
fluidrachm (4 Cc). 

Eucalypti. — Eucalyptus Globulus 7i O-S 

EuoNYMi (Wahoo). — Euonymus Atropurpureus 10 0.6 
Ferri Hypophosphitis. — Hypophosphite of 

Iron (ferric) I 00.6 

Ferri Lactatis i 0.06 

Ferri Phosphatis. — Phosphate of Iron (U. S. P.) 2 o. 1 2 
Ferri Phosphatis, Cinchonidin/E et Strych- 
nine. — Phosphate of Iron 2 0.12 

Cinchonidine . \ 0.03 

Sulphate of Strychnine YTo 0-0007 

Ferri Phosphatis, Quinine et Strychnine. 
— Phosphate of Iron, i grain (0.06); Qui- 
nine ^ 0.03 

Sulphate of Strychnine 6^4 o.ooi 

Ferri Pyrophosphatis . 2 0.12 

Ferri, Quinine et Strychnine. — Ferric Chlo- 
ride, I grain (0.06) ; Quinine Hydrochlorate \ 0.03 

Sulphate of Strychnine Y^ 0.0007 

Frangule (Buckthorn). — Rhamnus Frangula .15 i. 



PHARMACEUTICAL PREPARATIONS. 71 

Active Drug in 

I Fluidrachm. 4. Cc. 
Elixir — Grains. Gm. 

Gentians 2 0.12 

Gentians cum Tinctura Ferri Chloridi. — 

Tincture Citro-chloride of Iron 5 0.3 

Gentians et Ferri Phosphatis (ferrophos- 

phated). — Phosphate of Iron I 0.06 

Grindeli^. — Grindeha Robusta 4 0.25 

Guaran.5]. — Paullinia Cupana 12 0.75 

HuMULi 7J 0.5 

Hypophosphitum. — Calcium Hypophosphite . 3 0.2 

Sodium and Potassium Hypophosphites, each i 0.06 
Hypophosphitum cum Ferro. — Calcium and 

Sodium Hypophosphite, each ...... i 0.06 

Potassium and Iron Hypophosphites, each . \ 0.03 

LiTHii Bromidi 5 0.3 

LiTHII CiTRATIS 5 0.3 

LiTHii Salicylatis 5 0.3 

Malti et P^erri. — Phosphate of Iron .... i 0.06 

Malt Extract 15 i. 

Paraldehydi. — Paraldehyde 15 i. 

Pepsini. — Pepsin • . . . i 0.06 

Pepsini, Bismuthi et Strychnin^e. — Elixir Pep- 
sin and Bismuth, and Strychnine .... yig- 0.0007 

Pepsini et Bismuthi. — Pepsin i 0.06 

Bismuth and Ammonium Citrate 2 0.12 

Pepsini et Ferri. — Elixir of Pepsin and Tinc- 
ture Citro-chloride of Iron 5. 0.3 

Phosphori et Nucis Vomica. — Elixir Phos- 
phorus, with Tincture Nux Vomica ... 2 0.12 

Picis Compositum. — A combination of Prunus 
Virginiana,Tolu, Methylic Alcohol, and Sul- 
phate of Morphine . ^ 0.0015 

Pilocarpi (Jaborandi). — Pilocarpus Selloanus . 4 0.25 

PoTASSii Acetatis 5 0.3 

PoTASSii Acetatis et Juniperi. — Elixir Potass. 

Acet with Juniper 71 0.5 

PoTASSii Bromidi. — Potassium Bromide, effect- 
ually masked in Adjuvant Elixir .... 10 0.6 
An Elixir half this strength has also been used. 



72 A TEXT-BOOK OF MATERIA MEDIC A. 

Active Drug in 

I Fluidrachtn. ^ Cc. 
Elixir— Grains. Gm. 

Quinine Compositum (Red). — Sulphates of 
Quinine, \ grain (0.008), Cinchonidine and 

Cinchonine, each ^ 0.004 

Chiefly intended as a substitue for EHxir 
Cinchona when the administration of other 
constituents of the bark may be deemed ob- 
jectionable. 

QuiNiNiE ET Phosphatum Compositum. — Qui- 
nine Sulphate i O.015 

Phosphate of Iron i 0.06 

Calcium Lactophosphate . . . J 0.05 

Quinine Valerianatis et Strychnine. — Va- 
lerianate of Quinine I 0.06 

Sulphate of Strychnine yi-g- 0.0007 

Rhamni Purshiane (Cascara Sagrada). — Rham- 
nus Purshiana, its bitterness effectually masked 
with Elixirs of Glycyrrhiza and Taraxacum 
Compound ...-. 15 i. 

Rhamni Purshiane Compositum (Laxative 

Elixir; Elixir Purgans). — Cascara Sagrada . 7 J 0.5 

Senna and Juglans, each 5 0.3 

Associated with aromatics and correctives ; 
a most effective laxative in doses of from i to 2 
fluidrachms (4-8 Cc). 

Rhei. — Sweet Tincture of Rhubarb, represent- 
ing Rhubarb 2 J 0.15 

Rhei et Magnesia Acetatis. — Magnesium 

Acetate, 4 grains (0.25) ; Rhubarb. .... 7J 0.5 

RuBi Compositum (Blackberry Compound). — 
Blackberry Root, Galls, and Cinnamon (Sai- 
gon), in equal proportions, combined .... 10 0.6 
with smaller quantities of Cloves, Mace, and 
Ginger, in Blackberry Juice and Syrup. 

SoDii Bromidi. — Sodium Bromide, in Adjuvant 

Elixir 10 0.6 

SoDii Hypophosphitum 2 0.12 

SoDii Salicylatis (to be freshly prepared when 

required for use) 5 0-3 



PHARMACEUTICAL PREPARATIONS. 7^ 

Active Drug in 

I Fluidrach7n. ^ Cc. 
Elixir — Graitis. Gm. 

Stillingi/E Compositum. — Compound Fluid 

Extract of Stillingia, N. F 15 i. 

Strychnine Valerianatis y^ 0.0007 

TuRNER/E (Damiana). — Turnera Aphrodisiaca . 10 0.6 
Viburni Opuli Compositum. — Viburnum Opu- 

lus, Aletris Farinosa, each 5 0.3 

Trillium (Beth Root) 10 0.6 

Viburni Prunifolii (Black Haw) /J 0-5 

ZiNci Valerianatis. — Zinc Valerianate ... i 0.06 



CoRDiALE RuBi Fructus (Blackberry Cordial). — An aromatic 
Syrup of Blackberr}^ Juice, used as a mild astringent in bowel 
complaints. 

Succus LiMONis CUM Pepsino (Lime Juice and Pepsin). — Each 
fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. 

GLYCERITA— GLYCERITES. 

The Glycerites, or " Glyceroles," are solutions of substances in 
Glycerin. 

They are made either by direct solution, by heat, or by extrac- 
tion of a drug, as in Hydrastis ; one is made by chemical reaction 
— i. e. Boroglycerin. 

There are six official, comprising those used externally either 
alone or as additions to washes, gargles, injections, etc. : 

Percentage 
Glyceritum— by weight. 

Acidi Carbolici acid, carbolic 20. 

Acidi Tannici acid, tannic 20. 

Boroglycerini boroglyceride 50. 

Hydrastis representing hydrastis 100. 

The following are used chiefly as pharmacal agents ; the Gly- 
cerite of Starch as an excipient for Pill-masses ; and the Glycerite 
of Egg-yolk as an emulsifying agent : 
Glyceritum — 

Amyli water 10, starch 10. 

Vitelli fresh egg-yolk 45. 

The Glycerite of Starch is sometimes used externally, and is 



74 A TEXT-BOOK OF MA TERIA MEDICA. 

known as Glycerin Ointment, also as " plasma." The Glycerite of 
Egg-yolk, also known as " glyconin," has been used as an applica- 
tion to sore nipples. 

Unofficial Glycerites of the National Formulary. 
Glyceritum — 

Pepsini (Glycerole of Pepsin). — Each 4 Cc. (fluidrachm) repre- 
sents 0.3 (5 grains) of Pepsin. 
Picis Liquids (Tar). — Containing about 0.3(5 grains) of Tar. 
Tragacanth^. — Containing about 12 per cent, of tragacanth. 

MUCILAGINES— MUCILAGES. 

The Mucilages are prepared by extracting a mucilaginous drug 
with Water or dissolving a Gum in Water. 
The following four are official : 

G771. in 100 Cc, 
Mucilago — or percentage. 

Acaciae gum arabic 34. 

Sassafras Medullse sassafras pith 2. 

Tragacanthae glycerin 1 8 ; tragacanth 6. 

Ulmi slippery-elm bark 6. 

The Mucilages are chiefly employed as vehicles in Mixtures to 
aid in suspending insoluble substances ; as excipients in Pills and 
Troches ; and as emulsifying agents. They are sometimes used 
for their demulcent effect. 



THE LIQUID MIXTURES— INTERNAL. 

MISTUR/E— MIXTURES. 

The official Mixtures are Hquid preparations, for internal use, 
of medicinal substances dissolved or suspended in Water containing 
sugar, gum, or glycerin. They should be prepared extemporane- 
ously. The term Mixture is also applied to any combination of 
substances that cannot be otherwise classified. 

There are four official mixtures : 
Mistura — Cms. in 100 Cc. 

Cretae (Chalk Mixture) .... comp. chalk powder 20. 

cinnamon water 40 ; water, to 100. 

Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 

potass, carb. 0.8 

triturate with gradual addition of rose water 70. 

ferrous sulphate, 0.6 ; spir. lavend., 6 ; rose water, to lOO. 



THE LIQUID MIXTURES-INTERNAL. 7$ 

Mistura — Gms. in loo Cc. 

Glycyrrhizae Comp pure extract glycyrrhiza 3.0 

(Brown Mixture) Spirit ether nitrous 3 

wine antimony 6 

tinct. opium, camph. 12 

syrup 5 ; mucilage acacia 10; water, to 100, 

Rhei et Sodae sodium bicarbonate 3.5 

fl. exts. ipecac 0.3, rhubarb 1.5 

spirit peppermint 3.5 ; glycerin 35.; water, to 100 



Unofficial Mixtures of the Natioiial Forutulary. 
Mistura — 

AcACiiE — (Mistura Gummosa, Ph. Ger.). — Acacia, pulv.. Sugar, 
in Water. 

Should be freshly made when wanted for use. 

Adstringens et Escharotica (Villate's Solution). — Solu- 
tion of Lead Subacet. i\ fluidounces (45.); Sulphates of 
Copper, Zinc, each, i troy ounce (30.) ; Acetic Acid 13 fluid- 
ounces (360 Cc). 

Ammonii Chloridi (Mistura Solvens Simplex). — Ammonium 
Chloride, Purif Ext. Glycyrrhiza, each 180 grains (12.), in 
Water 16 fluidounces (450 Cc). 

Mistura (or Mixtiira) Solvens Stibiata is prepared by dis- 
solving 0.3 Antimony and Potassium Tartrate in 1000 Cc 
of Mistura Ammonii Chloridi. 

Camphor.e Acida (Mistura Antidysenterica ; Hope's Mix- 
ture). — Nitric Acid 120 mins. (8 Cc) ; Tinct. Opium 80 
mins. (5 Cc.) ; in Camphor Water 16 fluidounces (450 Cc). 

Camphors Aromatica (Parrish's Camphor Mixture). — Tinct. 
Lavender Comp. 4 fluidounces (120 Cc) ; Sugar 240 grains 
(15.); in Camphor Water 16 fluidounces (450 Cc). 

Carminativa (Dalby's Carminative). — Magnes. Carb. I troy 
ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 
180 mins. (12 Cc); Oils of Caraway, Fennel, Peppermint, 
each, 4 drops (o.i) ; Syrup 2\ fluidounces (75 Cc.) ; in 16 
fluidounces (450 Cc). Each fluidounce (30 Cc.) represents 
about I grain of Opium (0.06). 

Chloralis et Potassii Bromidi Composita (Mixture of 
Chloral and Bromide). — Each fluidrachm (4 Cc) contains 
15 grains (i.), each, of Chloral and Potassium Bromide, 



7^ A TEXT-BOOK OF MA TERIA MEDICA. 

Mistura — 

and \ grain (0.008), each, of Exts. Indian Cannabis and 

Hyoscyamus. 
Chloroformi et Cannabis Indict Composita {Chloroform 

Aiiodyjie). — Each fluidrachm (4 Cc.) represents j\ minims 

(0.5 Cc), each, of Chloroform and Tinct Indian Cannabis; 

3f minims (0.25 Cc.) Tinct. Capsicum ; and about \ grain 

(o.oi) of Morphine Sulph. 
Contra Diarrhceam [Cholera Mixture). — Tinctures of Opium, 

Capsicum, Rhubarb, and Spirits of Camphor and Pepper- 
mint, each, equal volumes. 

The above formula appears to be that in most general 

use, also known under the name of " Sun Mixture." 

Of other similar preparations in more or less general use, 

the following may be mentioned here : 

2. Looinis' Diaii'hea Mixture. — Tincture Opium, \ fluid- 
ounce (15 Cc.) ; Tincture Rhubarb, J fluidounce (15 Cc.) ; 
Tincture Catechu Comp., i fluidounce (30 Cc); Oil of Sas- 
safras, 20 minims (1.3 Cc.) ; Tincture Lavender Comp., to 
make 4 fluidounces (120 Cc), 

3. SquibUs DiarrJiea Mixture. — Tincture Opium, i fluid- 
ounce (30 Cc) ; Tincture Capsicum, i fluidounce (30 Cc) ; 
Spirit of Camphor, i fluidounce (30 Cc.) ; Purif Chloroform, 
180 minims (12 Cc) ; Alcohol, enough to make 5 fluidounces 
(150 Cc). 

4. Thielemann' s Mixture (Mixt. Thielemanni, Ph. Suec). — 
Wine Opium, i fluidounce (30 Cc.) ; Tinct. Valerian, \\ 
fluidounces (45 Cc.) ; Ether, \ fluidounce (15 Cc.) ; Oil 
Peppermint, 60 minims (4 Cc.) ; Fl. Ex. Ipecac, 1 5 minims 
(i Cc); Alcohol, to make 4 fluidounces (120 Cc), 

5. VelpeaiCs Diarrhea Mixture. — Tincture Opium, Tinc- 
ture Catechu Comp., Spirit Camphor, of each, equal volumes. 

Copaiba Composita- — 

1. Lafayette Mixture. — Copaiba, 2 fluidounces (60 Cc.) ; 
Tinct. Lavender Comp., 2 fluidounces (60 Cc.) ; Solution 
Potassa, 1 fluidounce (15 Cc) ; Spirit Nitr. Ether, 2 fluid- 
ounces (60 Cc); Syrup, 5 fluidounces (150 Cc.) ; Mucilage 
Dextrin, to make 16 fluidounces (450 Cc). This mixture 
should be well agitated when used. Each fluidrachm con- 
tains j\ minims of Copaiba. 

2. Chapman's Mixture. — Copaiba, 4 fluidounces (125 Cc.) ; 



THE LIQUID MIXTURES— INTERNAL. 77 

Mistura — 

Tinct. Lav. Comp., 240 minims (15.5 Cc.) ; Tincture Opium, 
240 minims (15.5 Cc.) ; Spirit Nitro. Ether, 4 fluidounces 
(125 Cc.) ; Mucilage Acacia, i J fluidounces (45 Cc.) ; Water, 
to make 16 fluidounces (450 Cc). 

ExPECTORANS, Stokes (Stokcs' Expectorant). — Ammonium 
Carb., 120 grains (8.); Fl. Ext. Senega, J fluidounce (15 
Cc.) ; Fl. Ext. Squill, \ fluidounce (15 Cc.) ; Tinct. Opium, 
Camph., 2 J fluidounces (80 Cc.) ; Water, ij fluidounces (45 
Cc); Syrup Tolu, to make 16 fluidounces (450 Cc). 

GuAiACi (Guaiac Mixture, Ph. Br.). — Resin Guaiac, Sugar, each, 
190 grains (12.5); Acacia Powder, 100 grains (7.) ; Cinna- 
mon Water, 16 fluidounces (450 Cc). To be well agitated 
when used. 

Magnesia et Asafoetid^e (U. S. P. 1880.). — Dewees' Carmina- 
tive. — Magnesium Carbonate, 90 grains (6.0); Tinct. Asa- 
foetida, 2 fluidrachms (8 Cc.) ; Tinct. Opium, 20 minims (1.2 
Cc.) ; Sugar, 180 grains (12.0); Water, to make 4 fluid- 
ounces (120 Cc). 

Olei Balsamica (Balsamum Vitae Hoflmanni, Ph. Ger.). — 
A solution of Oils of Lavender, Thyme, Lemon, Mace, 
Orange-flowers, Cloves, Cinnamon, and Balsam Peru in 
Alcohol. 

Olei Picis (Tar Mixture). — A mixture of Oil of Tar, |- fluid- 
ounce (15 Cc.) ; Chloroform, 75 minims (5 Cc.) ; Oil of Pep- 
permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- 
ounces (450 Cc). 

Rhei Composita (Squibb's Rhubarb Mixture). — Fl. Ext. 
Rhubarb, 120 minims (6. Cc.) ; FL Ext. Ipecac, 16 minims 
(i. Cc) ; Sodium Bicarb., 330 grains (11.) ; Glycerin, 6 fluid- 
ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). 

Sassafras et Opii (Mist. Opii Alkalina ; Godfrey's Cordial). — 
A mixture of Oil of Sassafras. Tincture of Opium, and Potass. 
Carb. in Molasses, Alcohol, and Water. Each fluidrachm 
(4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- 
ing to \ grain (o.oi) Opium. 

SoD^ ET Mentha (Soda Mint). — Sodium Bicarb., 320 grains 
(20.) ; Spirit Ammonia Arom., 4 Cc. (60 minims) ; Spear- 
mint Water, 16 fluidounces (450 Cc). 

Splenetica (Spleen Mixture ; Gadberry's Mixture). — Iron 
Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains 



78 A TEXT-BOOK OF MA TERIA MEDICA. 

Mistura — 

(/.); Potassium Nitrate, 300 grains (20.), in Water, 16 fluid- 
ounces (450 Cc). 
SuLPHURiCA AciDA (Haller's Acid Elixir, Ph. Gen). — Sul- 
phuric Acid, I part ; Alcohol, to make 4 parts, by weight. 

EMULSA— EMULSIONS. 

Emulsions are liquid preparations consisting of oily ^ fatty, resin- 
ous, or otherwise insoluble substances suspended in watery liquids 
by the intervention of gum, mucilage, or other viscid matter. 

For the internal administration of Oils it is often necessary to 
exhibit them in a palatable form, so that they may be borne by the 
stomach and their assimilation favored. This is usually effected by 
suspending the oil in a watery liquid or mixture by means of an 
e^nulsifying agent, such as acacia, etc. 

Many natural substances are intimate mixtures of oils or fats 
with water, in the form of an emulsion. Of animal products, Milk 
is a most perfect emulsion; so is Egg-yolk. From the Milk-juice 
of some plants the water evaporates and the dried milk-juice col- 
lects in the seeds, as in almonds and other nuts, or exudes from 
other portions of the plant when the parts are wounded ; in this 
way the gum-resins of asafoetida, etc. are produced. From these 
substances Emulsions may be obtained by restoring the water lost 
by evaporation — that is, by rubbing them with water in a mortar. 
In this way the so-called natural Emulsions are made. 

Artificial Emulsions. 

These are made by mixing the Oil with a certain proportion of 
the emulsifying agent, adding Water, and triturating the mixture in 
a mortar or agitating it in a flask. 

There are various methods, but these are general rules : 

The emulsification of the oil should be complete before the mixture is made up to the 
required measure. 

When alcoholic liquids are to be added, they should first be diluted as much as 
possible. 

Salts should be dissolved before being added. 

No heat should be employed, as the oil separates when an emulsion is heated. 

Emulsions should he ffeshfy prepared and be preserved in a cold -^XdiCe. 

The most common emulsifying agent is Powdered Gum Acacia 
(Acacia pulv.). The Oil is thoroughly mixed by trituration in a 
mortar with one-fourth its weight of powdered Acacia. To this 
07ie and a half times as much water as of gum is added at once, and 
the mixture is rapidly triturated with a rotary motion of the pestle 



THE LIQUID MIXTURES— INTERNAL. 79 

until it becomes stiff and assumes a milk-white color. This so- 
called " mother-emulsion " may now be diluted to the required 
measure, and other substances, flavors, etc. be added. 

Powdered Tragacanth may be used in the same way or in the 
form of mucilage, but it does not produce so permanent emulsions 
as does gum acacia. 

Mucilage of Acacia or of Irish Moss is not so satisfactor}^ as 
powdered gum : while it produces a good emulsion, the division of 
the oil-globules is not so thorough as in the preceding : emulsifica- 
tion being incomplete, the mixture more rapidly separates into a 
heavier, watery liquid and a lighter, thick, gelatinous emulsion, 
which requires thorough mixing before use. 

Extract of malt is an excellent emulsifying agent when its use is admissible. The 
Oil should be added to the Malt Extract contained in a capacious mortar, and incorporated 
in small quantities at a time. A good article will emulsify an equal volume of cod- 
liver oil. 

Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the 
most palatable, but they rapidly ferment and spoil. 

Glycerin and sugar added to emulsions for the purpose of preservation and palata- 
bility induce separation, and their use is not advisable. 

Emulsification ** by intervention " is the best and only reliable 
method to be employed with Ethereal Oils and all substances of 
themselves not emulsifiable. The process is illustrated in the 
official Chloroform Emulsion. 

Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in 
twice its volume of a bland fixed oil (Almond Oil), incorporating an equal weight of 
powdered Acacia, adding Water, and proceeding as with an ordinary emulsion. 

Pancreatin emulsionizes fats in preparing them for digestion, but it does not produce 
:a permanent emulsion when used artificially. While, therefore, not a rehable emulsifying 
agent, it aids the assimilation of oils, and its addition to emulsions is sometimes therapeu- 
tically desirable. As it is only active in alkaline media, the Emulsion should be prepared 
with a httle Sodium Bicarbonate. 

The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, 
nor is the use of Soap-bark to be recommended. 

Of the four official Emulsions three are natural emulsions ; one 
is artificial : 

G?n. in 100 Cc, 
Emulsum — or percentage by vol. 

Ammoniaci ammoniac 4, 

Amygdalae sweet almond 6, 

sugar 3 ; acacia i 

Asafoetidae asafcetida, in select tears 6 

Chloroformi .... tragacanth powd. 1.5 ; chloroform 4 

expressed oil almond 6 ; water, to 100. 



8o A TEXT-BOOK OF MATERIA MEDIC A. 

Shake the Chloroform and Tragacanth together in a dry bottle, 
incorporate 25 Cc. Water, then the Almond Oil in small quantities, 
and finally in the same way add the remainder of the Water. 

Unofficial Emulsions of the National Formulary. 

Emulsions should, of all pharmaceuticals, be prepared within a 
reasonable period previous to the time of dispensing. A true 
emulsion should contain the oil simply suspended in the form of a 
mechanical mixture, which, from its very character, cannot with- 
stand the effects of variation in temperature any better than a 
natural emulsion, such as milk or emulsions of almonds, gum- 
resins, etc., and consequently quickly degenerates or spoils. 

An emulsion may be perfect — that is, the oil-globules entirely 
extinguished — yet a separation similar to that occurring in milk 
will take place, which, though in its first stage not so objection- 
able, will eventually impair the medicinal value of the preparation. 
These reasons are, it is believed, sufficient to condemn the various 
*' ready-made " or patent emulsions, and to justify the physician in 
prescribing such as are kept on hand by the pharmacist, in smaller 
quantities, prepared according to these formulas. 

A typical formula for emulsions, with Acacia, is — 

;^. Olei Morrhuse 120 Cc, 5iv; 

Acaciae pulv 30 Gm., % ; 

Aquse q. s. ad 240 Cc, ^viij. 

Emulsify by trituration in a mortar, and add the flavoring. 

The following are flavors employed: (i) Gaultheria, (2) gaul- 
theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, 
and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- 
theria and bitter almond, (7) oil of neroH, bitter almond, and cloves. 
Unless otherwise specified, that designated as No. 5 may be em- 
ployed in these Emulsions. 

The following formulas may be useful as indicating the form of 
prescription for any combination desired. Hypophosphite Salts or 
any medication desired may usually be dissolved in the water 
directed in the formula, should a preparation be indicated different 
from any of the following emulsions of the N. F. : 
Emulsio — 

Olei Morrhu^ cum Calcii et Sodii Phosphatibus. — Cal- 
cium Phosphate, Sodium Phosphate, of each, i grain in I 
fluidrachm (0.06 in 4 Cc). 



EXTRACTIVE PREPARATIONS. 8l 

Olei Morrhu/e cum Calcii Lactophosphate. — Calcium 
Lactophosphate, 3 grains in i fluidrachm (0.2 in 4 Cc). 

Olei Morrhu.e cum Calcii Phosphate. — Calcium Phos- 
phate, 2 grains in i fluidrachm {0.12 in 4 Cc). 

Olei Morrhu^ cum Extracto Malti. — Contains 40 per 
cent. Extract of Malt. 

Olei Morrhu.e cum Hypophosphite. — The Hypophosphite 
Salt or any combination oi the following : Calcium, Po- 
tassium, Sodium, or Iron, to be directed by the prescriber, 
8 grains to the fluidounce (0.5 in 30 Cc). 

Olei Morrhu.e cum Pruno Virginiana. — Wild Cherry 
(Fluid Ext.), \ fluidrachm to i fluidounce (2 Cc in 30 Cc). 

Olei Ricini. — i fluidounce (30 Cc) contains 2\ fluidrachms 
(10 Cc.) Castor Oil, disguised by the addition of Vanilla. 

Olei TEREBiNTHiNiE. — Contains i fluidrachm (4 Cc) Oil of 
Turpentine i fluidounce (in 30 Cc), prepared according to 
the following formula : 

I^. Olei Terebinthinse ...... ^iv, 12.5 Cc; 

Acacias pulv gr. xxx, 2.0 

Vitelli Ovi (Egg-yolk) ; 

Elixir Aromatici .... ana 3iv, 1 5 Cc ; 
Aquae Cinnamomi . . q. s. ad ^iv, lOO Cc 
Make an emulsion by trituration in a mortar. 

Phosphatica (Phosphatic Emulsion). — Prepared with Glycerite 
of Egg-yolk, and contains in i fluidounce (30 Cc.) Cod 
Liver Oil, 2 fluidrachms (8 Cc.) ; Dilute Phosphoric Acid, 
22i minims (1.5 Cc) ; Jamaica Rum, flavored with Bitter 
Almond and Oranp;e Flower Water. 



EXTRACTIVE PREPARATIONS. 

The active medicinal constituents, or principles, of crude drugs 
are obtained by extraction. Extraction is effected either by macera- 
tion, expression, and fihration or straining, or by maceration with 
heat, when it is called digestion, or by percolation. The liquid 
employed, termed menstruum (pi. menstrua), may be Water or Al- 
cohol, or Alcohol and Water in various proportions, sometimes 
with Glycerin. A few drugs require alkaline menstrua, some 
acid menstrua, while the oleoresins are made with Ether. 



83 A TEXT-BOOK OF MATERIA MEDIC A. 

The Infusions and Decoctions are the simplest preparations made 
by extraction, and represent most nearly all the soluble constitu- 
ents of the drugs. But not all drugs are adapted to this method 
of extraction nor to this exceedingly effective, though not espe- 
cially elegant, form of exhibition. 

The most generally convenient and effective class of extractive 
preparations are the Tinctures. They are the simplest form of alco- 
holic preparations, and the other more concentrated preparations 
are usually first obtained as tinctures and then concentrated by 
evaporation, so as to yield the fluid extract, extract, or resin 
respectively. 

The only accurate method for determining the doses of extrac- 
tive preparations is to compare their drug-strength. 

Thus, the doses of the respective preparations of Nux Vomica, 
based upon their relative drug-strength, would be as follows : 

Average Dose 
of Drug. of Preparation. 



Tincture . . .20%, i in 5, 3 grains (0.2) = 15 minims (i. Cc). 
Fluid Extract 100%, i in i, 3 grains (0.2)= 3 minims (0.2 Cc). 
Extract . . . 1000 % , 10 in i, 3 grains (0.2) =3^ grain (0.02 Gm.). 

In the same way the doses of the preparations of Opium may 
be presented : 

Average Dose 
of Drug. of Preparation. 



Tincture of Opium . 10 %, i grain (0.06) = 10 minims (0.6 Cc). 
" " deod. 10%, I grain (0.06) = 10 minims (0.6 Cc). 

Vinegar of Opium . 10%, i grain (0.06) = 10 minims (0.6 Cc). 
Wine of Opium . . 10%, I grain (0.06) -= 10 minims (0.6 Cc). 
Extract of Opium . 150%, i grain (0.06) = | grain (0.04). 

While the preparations of these two drugs are standardized 
according to their alkaloid percentage strength in the U. S. P., 
such strength is not as available for computing or estimating doses 
as is the drug-strength. The determination of alkaloidal percentage 
in preparations is a check upon their preparation, but is not of so 
much importance to the physician as it is that the preparations be 
made by a skilful and conscientious pharmacist, from the very best 
quality of material, in a thorough manner. 



EXTRACTIVE PREPARATIONS. 83 

INFUSA— INFUSIONS. 
Unless otherwise directed, Infusions are prepared by the general 
official process : 

Of the Drug, coarsely comminuted 5 Gm. 

Boiling Water 100 Cc. 

Pour the boiling Water on the Drug in a suitable vessel, provided with a cover, and 
let it stand for half an hour ; strain, and add enough Water through the strainer to make 
100 Cc. 

Caution.— i:\i^ strength of Infusions of powerful drugs — e. g. 
Ipecac— should be especially prescribed. The following Infusions 
are official, being prepared of different strengths and by other 
processes than directed in the general formula: 

Gjn. in 100 Cc. 

Infusum Digitalis . alcohol, 10; cinnamon water, 15 ; digitalis 1.5 
Infusum Sennae Comp. (Black Draught) . . fennel 2 ; senna 6. 
manna, magnesium sulph., of each 12. 
Drugs whose active principles are volatile or changed by heat 
are prepared by percolation without heat, or cold Infusion : 

Gm. in 100 Cc. 
Infusum Cinchonae .... acid arom. sulph. i ; cinchona 6. 
Infusum Pruni Virginianae wild cherry 4. 

Unofficial Infusions of the National Formulary. 
Infusum — 

Brayer^ (U. S. p. 1880). — Brayera (Cusso), 6 ; Boiling Water, 

100 Cc. To be dispensed without straining the mixture. 
Gentians Compositum Fortius. — F'or preparing Infusum 

Gentianae Compositum by mixing i volume with 3 volumes 

of water. 
RoSiE Compositum (Compound Infusion of Rose, Ph. Br.). — 

An infusion of Red Rose in diluted Sulphuric Acid, Sugar, 

and Water. 

The Species (Teas) are mixtures of drugs contused or bruised 
for the preparation of Cataplasms ; or Infusions and Decoctions, 
sometimes designated as Haustus (Draught). The following are 
in the National Formulary: 
Species^— 

Emollientes (Emollient Cataplasm, Ph. Ger.). — A mixture of 
Althaea Leaves, Mallow Leaves, MeHlot Tops, Matricaria, 
and Flaxseed, equal parts of each. 



84 A TEXT-BOOK OF MA TERIA MEDICA. 

Species — 

Laxantes (St. Germain Tea, Ph. Ger.). — A mixture of Senna, 
Elder-flowers, Fennel, Anise, and Potassium Bitartrate. 

Pectorales (Breast Tea, Ph. Ger.). — A mixture of Althaea, 
Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris 
Root. 

Infusujn Pcctorale (Pectoral Infusion, or Infusion of Pec- 
toral Species) is made by infusing i troy ounce (30 Gm.) 
of the above in the usual manner, so as to obtain 10 fluid- 
ounces (300 Cc.) of strained product. 

DECOCTA— DECOCTIONS. 

Unless otherwise directed. Decoctions are prepared according" 
to the following general process : 

Of the Drug, coarsely comminuted 5 Gm. 

Boiling water, to make 100 Cc. 

Pour the boiling Water on the Drug, contained in a suitable vessel provided with a 
cover, bring it to a boil, and let it boil for fifteen minutes; let it cool to 40° C. (104° F.),, 
express, strain, and add cold Water through the strainer to make 100 Cc. 

Caution as with Infusions. 

The following Decoctions are official, as being made of strengths 
and methods other than those directed in the general process : 

Gm. in 100 Cc. 

Decoctum Cetrariae Iceland moss 5. 

Decoctum Sarsaparillae Comp. mezereum i ; sarsaparilla 10. 
glycyrrhiza, sassafras, guaiac wood, of each 2. 

Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes,, 
Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh, Tinct. Cardamom 
Comp., and Water. — Extempore. 

ACETA— VINEGARS. 

The Vinegars are made by extraction with Dilute Acetic Acid. 

By maceration : 

Gjti. in 100 Cc. 

Acetum Opii (Black Drop) . sugar 20; nutmeg 3 ; opium 10. 
Scillae squill IQ. 

The Vinegars of Lobelia and Sanguinaria (U. S. P. 1880) were of the same strength. 

VINA— WINES. 
The Wines are made by solution, by maceration, or by macera- 
tion and percolation. The Menstruum is White Wine, to which from 



EXTRACTIVE PREPARATIONS. 85 

10 to 15 per cent, of Alcohol is added to aid in the extraction and 
the preservation. There are ten Wines official. 

The Natural Wines : Vinum Album and Vinum Rubrum are 
treated under Alcohol. 
Vinum — G771. in 100 Cc. 

Antimonii . . . antimony, potass, tart. (sol. water) 0.4 

Colchici Radicis colchicum root 40. 

Colchici Seminis colchicum seed 15. 

Ergotae ergot 15. 

Ferri Amarum . . soluble iron and quinine citrate 5. 
(Bitter Wine of Iron) tinct. orange peel 15 ; syrup 30. 

Ferri Citratis .... iron and ammonium citrate 4. 
syrup 10; tinct. orange peel 15. 

Ipecacuanhse alcohol 10; fl. ext. ipecac 10. 

Opii ...... cinnamon, cloves, each, I ; opium 10. 

The Dose of the Vinegar and Wine of Opium is the same, 10 
minims (0.6) representing i grain {0.06) opii pulveris. The dose of 
the Wine of Colchicum Root is 10 minims (0.6), it being nearly 
three times the strength of the Wine of Colchicum Seed, of which 
the dose is 30 minims (2 Cc), 

Unofficial Wines of the National Formulary. 
The Wines, with a few exceptions, are prepared with White 
Wine {Vinum album, U. S.), usually with the addition of 10 per 
cent, of Alcohol, in order better to preserve the preparation. 
Vinum — 

Aloes (U. S. P. 1880). — Representing 6 per cent, of Aloes 

with Aromatics. 
AuRANTii. — Sherry Wine flavored with Orange. 
AuRANTii CoMPOSiTUM (Elixir Aurantiorum Compositum). — A 
combination of Bitter Orange Peel, Absinthium, Menyanthes, 
Cascarilla, Cinnamon, and Gentian, in Sherry W^ine. Useful 
as a stomachic tonic in doses of i fluidrachm (4 Cc). 
Carnis (Beef and Wine). — Each fluidrachm (4 Cc.) represents 
2 grains (0,12) of Extract of Beef 

The Extract of Beef in this and similar preparations is that which is pre- 
pared by Liebig's method. 

Carnis et Ferri (Beef, Wine, and Iron). — Each fluidrachm 
(4 Cc) represents 2 grains (0.12) of Extract of Beef and 
2 minims (0,12) Tincture of Citro-chloride ("Tasteless" 
Tincture) of Iron. 



86 A TEXT-BOOK OF MATERIA MEDIC A. 

Vinum — 

Carnis, Ferri et Cinchona (Beef, Wine, Iron, and Cinchona). 

— Each fluidrachm(4 Cc.) represents 2 grains (0.12) Extract 

of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and 

small quantities of Cinchona alkaloids, in Angelica Wine. 
Coc^ (Erythroxyli). — Each fluidounce (30 Cc.) represents 

30 grains (2 Gm.) of Coca in Claret Wine. 
Coc^ Aromaticum. — Each fluidounce (30 Cc.) represents 30 

grains (2 Gm.) of Coca with Aromatics. 
Fraxini Americans (White Ash).— Each fluidrachm (4 Cc.) 

represents 30 grains (2 Gm.) of Fraxinus (bark). 
Pepsini (Pepsin). — Each fluidrachm (4 Cc.) represents i grain 

(0.06) of Pepsin. 
Picis (Tar). — A saturated solution of Tar, in Sherry Wine. 
Pruni Virginians (Wild Cherry). — Each fluidrachm (4 Cc.) 

represents 15 grains (i Gm.) of Wild Cherry, in Angelica 

Wine. 
Pruni Virginians Ferratum (Wild Cherry, Ferrated). — Each 

fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture 

of Citro-chloride of Iron and I3|- grains (0.9 Gm.) of Wild 

Cherry, in AngeHca Wine. 
Rhei (U. S. p. 1880). — Representing 10 per cent, of Rhubarb 

and I per cent, of Calamus. 

TINCTURE— TINCTURES. 

Tinctures are liquid preparations made by the extraction of 
Drugs with menstrua of Alcohol and Water in various propor- 
tions. They are prepared by maceration and filtration ; also by 
percolation : 

By maceration and filtration, those containing resins and oleo- 
resins, Musk, and tinctures of fresh herbs ; in a few instances with 
heat, the Tincture of Quillaja and Tincture of Strophanthus. 

By percolation, when prepared from dried vegetable drugs — i. e. 
barks, leaves, roots, etc., usually after brief maceration. 

By solution, mixing a solution (chloride of iron) or dissolving 
a solid in Alcohol (Iodine, Ext. Nux Vomica). 

Assayed Tinctures. — Two of the most important Tinctures are 
required to be of certain specified alkaloidal strengths, and their 
classification according to their respective drug-strengths is there- 
fore only approximately correct. 

Tinctura Opii is made so as to represent from 1.3 to 1.5 per 



EXTRACTIVE PREPARATIONS. 



87 



cent, of crystallized morphine, the proportion obtained from 10 per 
cent, of Opii Pulvis, U. S. 

Tmctura Nucis Voviicce is made by solution of 2 per cent, of the 
official Extract, representing about ten times its weight of the drug ; 
the Tincture therefore represents 20 per cent, of the drug, and con- 
tains 0.3 per cent, total alkaloids. 

Tincturse Herbarum Recentium. — Tinctures of Fresh Herbs, 
or " Green Tinctures," similar to the Homoeopathic or so-called 
" German Tinctures," also to the specific tinctures of the Eclectics, 
when not otherwise directed are to be prepared by the following 
general formula : 

Take of the fresh herb, bruised or crushed, 50 Gm. ; macerate for fourteen days in 
Alcohol 100 Cc. ; express the liquid and filter. 



Tinctures of the U. S. P. 



Name. 



Drug:. 



Tinctura — 

Aconiti 

Aloes 



•{ 



Aloes et Myrrhae 



Arnicse Florum . 
Arnicse Radicis . 
Asafoetidae . . . 
Aurantii Amaras . 
Aurantii Dulcis . 
Belladonnse Foliorum 
Benzoini 



Benzoini Composita 
(TurHngton's Bal- 
sam). 



Bryonise . . . 
Calendulas . . 
Calumbae . . . 
Cannabis Indicas 
Canlharidis . . 
Capsici .... 
Cardamomi . . 



Cardamomi 
Composita 



}■ 



Root . . 
Aloes 
Licorice 
Aloes . . 
Myrrh . 
Licorice . 
Flowers . 
Root . . 
Gum resin 
Bitter Orange 
Sweet . . 
Leaves . . 
Balsam . . 
Benzoin 
Storax . . 
Tolu . . . 
Aloes . . . 
Root . . . 
Florets . . 
Root . • • 
Flower tops 
Insect . . 
Fruit . . . 
Fruit . . . 
Cardamom . 
Cassia Cinnam 
Caraway 
Cochineal 
Glycerin . 



Gm. 

in 
100 Cc 

35 
10 
10 
10 
10 
10 . 
20 
10 
20 
peel 20 
20 

15 
20 
12^ 

8 

4 

2 J 

10 

20 

10 

15 

5 

5 

10 
2 
2 



Average Dose. 



Menstrua. 

Alcohol, Drug. Rep. Tinct. 

per cent. Grains. Gm. Cc. Min. 

70 I 0.06 0.2 3 

50 6 0.4 4. 60 



0.5 
5 



75 

50 

65 
100 

60 
100 

50 
100 

100 



100 

100 

60 

100 

100 

95 

50 



50 



3 
6 
6 

5 

1 

¥ 



1. 

2. 

2. 

2. 

2. 

0.6 

2. 



0.8 

0.2 
0.2 
0.4 
0.4 
0.4 
0.1 
0.4 

0-5 



0,2 
0.4 
0.4 

0-3 

0.015 0.3 

0.1 2. 

0,4 4. 



60 

15 
30 
30 
30 

30 
10 

30 
30 



30 
30 
60 

30 
5 

30 
60 



60 



88 



A TEXT-BOOK OF MATERIA MEDICA. 



Name. 

Tinctura — 

Catechu Composita 



Drug. 



Catechu . 
Cinnamon 



Chiratse Herb . 

Cimicifugse Rhizome 

Cinchonae Bark . . 

' Red Cinchona 



Bitter Orange 
Serpentaria 
L Glycerin . 



Cinchonse Composita 
(Huxham's Tinc- 
ture). 

Cinnamomi Ceylon 

Colchici Seminis . . . Seed 

Croci Saffron . 

Cubebae Fruit . 

Digitalis Leaves . 

Ferri Chloridi .... Solution 

Gallae Nutgall 

Gelsemii Root . 

{Gentian 
Bitter Orange 
Cardamom 
Guaiaci ....... Resin . 

Guaiaci Ammoniata . . Resin . 

Humuli Hops . 

Hydrastis Rhizome 

Hyoscyami Herb . 

lodi Iodine . 

f Ipecac . 
Ipecacuanhae et Opii { Qpium deod 

Kino Insp. juice 

Kramerise Rhatany . 

Lactucarii Insp. juice 

c Oil Lavender 

I Oil Rosemary 

I Cinnamon . 
Lavandulae Composita -| p, 

(For flavoring.) ^""^^^^^ ' ' 

^ Red Saunders 

Lobeliae Herb . . . 

Matico Leaves . . . 

Moschi Musk . . . 

Myrrhae Gum resin . 

Nucis Vomicae .... Extract . . 
Opii Pulv. Opium 

r Opium pulv 



peel 8 I 



Opii Camphorata 
(Paregoric.) 



j Acid Benzoic 
1 Camphor . . 

Oil Anise 
. Glycerin . . 



Gm. 

in 
100 Cc. 
lO X 
lO i 
lO 
20 
20 



Menstrua. 
Alcohol, Drug, 

per cent. Grains. Gm. 

50 12 0.8 



Average Dose. 



Rep. Tinct. 



lO] 



2 

7.5 J 

10 

15 
10 
20 
15 

25 Cc 
20 

20 
20 
20 
20 
15 
7 

10 
10 
10 
20 

50 
0.8 
0.2 
2. 
0-5 



20 
10 

5 

20 
2 

10 
0.4 
0.4 
0.4 
0.4 
4. - 



65 6 
[oo 12 
67 12 o 



\ ^5 



75 
60 

50 
100 

50 
75 
90 

65 

60 

100 

50 

50 

50 

100 

20 

65 
50 
50 



75 



50 
50 
50 

iOO 

75 
50 



0.4 
0.8 



Cc. 

4. 

4- 
4- 
4- 



12 0.8 

6 0.4 

5 0-3 

6 0.4 
12 0.8 

2\ 0.15 

4 0.25 
12 0.8 

2\ 0.15 I 

12 0.8 4 

12 0.8 4 

6 0.4 2 

12 0.8 4 

12 0.8 4 

5 0-3 2 

Only externally 



I 0.06 

6 0.4 
[2 0.8 
For syrup. 



0.4 

0.2 

0.1 

0.4 

0.02 

0.06 



2. 
2. 
2. 
2. 
I. 
0.6 



Min. 
60 

60 
60 
60 

60 

60 

30 
60 
60 
15 
15 
60 

15 

60 

60 

30 
60 
60 
30 



60 
60 



30 



30 
30 
30 
30 
15 
10 



Opium 
50 \ 0.015 4- 60 



EXTRACTIVE PREPARATIONS. 



89 



Name. 

Tinctura — 

Opii Deodorata 
Physostigmatis . 
Pyrethri . . . 
Quassise . . . 
Quillajse . . . 



Rhei 



Rhei Aromatica . . \ 
(For syrup.) j 

L 

r 

Rhei Dulcis (Sweet ^ j 
Tincture of Rhu- \ \ 
barb.) ^ 



Sanguinariae 

Scillge 

Serpentarige 

Stramonii Seminis . . 

Strophanthi 

Sumbul 

Tolutana 

Valerianae 

Valerianae Ammoniatge. 

Vanillae 

Veratri Viridi . . . . 
Zingiberis 



Drug. 

Opium . . . 
Calabar Bean 
Pellitory . 
Wood . . 
Soap Bark 
Rhubarb . 
Cardamom 
Rhubarb . 
Cinnamon 
Cloves . . 
Nutmeg . 
Glycerin . 
Rhubarb . 
Glycyrrhiza 
Anise . . 
Cardamom 
Glycerin . 
Blood-root 
Squill . , 
Rhizome . 
Seed . . 
Seed . . 
Musk-root 
Tolu . . 
Root . . 
Root . . 
Fruit . . 
Rhizome . 
Ginger . . 



Gm. 


Menstrua 
Alcohol, 




Average Dose. 


in 


Drug. 


Rep. 


Tinct. 


00 Cc 


. per cent. 


Grains 


. Gm. 


Cc. 


Min. 


10 


20 


I 


0.06 


0.6 


10 


15 


1 00 


I 


0.06 


0.4 


7 


20 


100 


Externally. 






10 


35 


3 


0.2 


2. 


30 


20 


35 


6 


0.4 


2. 


30 


'D - 


8 


0.5 


4. 


60 


20^ 












4 
4 


50 


15 


I. 


4. 


60 


2 












loJ 












lO] 












4 
4 


50 


• ' 


• • 


b. 


120 


10- 












15 


60 


5 


0-3 


2. 


30 


15 


75 


^\ 


0.15 


I. 


15 


10 


65 


6 


0.4 


4- 


60 


15 


50 


H 


0.15 


I. 


15 


5 


65 


\ 


0.015 


0.3 


5 


10 


65 


3 


0.2 


2. 


30 


10 


100 


3 


0.2 


2. 


30 


20 


75 


12 


0.8 


4. 


60 


20 




6 


0.4 


2. 


30 


10 


65 


3 


0.2 


2. 


30 


40 


100 


2 


0.12 


0.3 


5 


20 


100 


6 


0.4 


2. 


30 



U?zofficial Tinctures of the National Formulary. 
Tinctura— 

Amara (Bitter Tincture, Ph. Ger.). — Containing Gentian, Cen- 
taury, Bitter Orange Peel, Orange Berries, and Zedoary. 

Antacrida (Dysmenorrhoea Mixture ; Fenner's Guaiac Mix- 
ture). — A mixture of Guaiac, Canada Turpentine, Oil of Sas- 
safras, and \ grain (0.02) Corrosive Mercuric Chloride in each 
fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 
1.3 Cc). 

Antiperiodica (Warburg's Tincture). — With Aloes : Rhubarb, 
Angelica Seed, of each, grains 56 (4.); Elecampane, Saf- 
fron, Fennel, of each, grains 28 (2.) ; Aloes (aq. ext.), Gen- 
tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of 
each, grains 14 (i.); Quinine Sulphate, grains 160 (10.); 
Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 



90 A TEXT-BOOK OF MATERIA MEDIC A. 

Tinctura — 

Antiperiodica (Warburg's). — The preceding without Aloes, 
Each fluidounce (30 Cc.) of either tincture contains la 
grains (0.6) of Quinine Sulphate. 

Aromatica (Stomachic, Ph. Ger.). — A combination of Cinna- 
mon, Ginger, Galangal, Cloves, and Cardamom. 

Capsici et Myrrhs (Hot Drops). — The preparation popularly 
known as " Number Six." 

CiNCHONyE Detannat^. — For admixture with preparations 
containing Iron. 

CoNii (U. S. P. 1880). — Representing 15 per cent, of Conium.. 

CoTO. — This preparation contains 7 J grains (0.5) true Bolivian 
Bark in each fluidrachm (4 Cc). The Para Goto, frequently 
employed, differs considerably from the above. 

Ferri Chloridi ^therea (Bestucheff's Tincture ; Lamott's 
Drops, Ph. Ger.). — Each fluidrachm (4 Cc.) represents about 
\ grain (0.3) Metallic Iron. 

Ferri Citro-chloridi (Tasteless Tincture of Iron). — Practi- 
cally identical in the strength of Iron, but not in Alcohol, 
with the official Tincture of Chloride of Iron, containing an 
amount of Iron equivalent to j\ grains (0.5) of Dry Chloride 
of Iron in each fluidrachm (4 Cc). 

A convenient form of Iron for admixture with Tinctures 
of vegetable astringent drugs, such as Gentian and Cinchona, 
preparations of which it does not, unlike other iron com- 
pounds, discolor. 

Ferri Pomata (Ferrated Extract of Apples ; Malate of Iron, 
Ph. Ger.). — Each fluidrachm (4 Cc.) represents about | 
grain (0.025) of Metallic Iron. 

GuAiAci CoMPOSiTA (Dewces' Tincture of Guaiac). — Each 
fluidrachm (4 Cc.) represents 7 J grains (0.5) Guaiac. 

Ignati^ (U. S. p. 1880). — Representing 10 per cent, of 
Ignatia. 

loDi (Churchill's). — A solution of 10 grains (0.6) Iodine in 
each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. 
Not to be confounded with Churchill's Iodine Caustic 
(Liquor lodi Causticus). 

loDi Decolorata (Colorless Tincture of Iodine). — Contain- 
ing about I per cent, of Ammonium Iodide, with some 
other Iodine compounds, in alcohoHc solution ; for external 
use. 



EXTRACTIVE PREPARATIONS. 9^ 

Tinctura — 

Jalaps (U. S. P. 1870). — Each fluidrachm (4 Cc.) represents 
about 10 grains (0.6) Jalap. 

Jalaps Composita. — Each fluidrachm (4 Cc.) represents j\ 
grains (0.5) Jalap and about 2 grains (0.12) Scammony. 

Kino Composita — 

Tinctures of Kino, Opium, each . . minims 180 12. Cc. 

Spirit of Camphor " 130 8.5 " 

Oil of Cloves " 2\ 0.15 " 

Aromatic Spirit of Ammonia . . " 15 i. " 

Cochineal grains 16 i. " 

Diluted Alcohol to make fluidounces 4 .... 120. " 

Each fluidrachm (4 Cc.) represents \ grain (0.03), each, 
of Kino and Opium. 

Papaveris (Poppy). — Each fluidrachm (4 Cc.) represents 30 
grains (2.) of Poppy (Capsule). 

Pectoralis (Bateman's Pectoral Drops). — A popular mixture 
of Opium, Catechu, Camphor, and Oil of Anise, containing 
2\ minims (0.15) Tincture of Opium (^ grain Pulv. Opium) 
in each fluidrachm (4 Cc). 

Persionis (Cudbear). — Intended as a coloring agent when a 
bright-red tint or color is to be produced, particularly in 
acid liquids. 

Persionis Composita. — A mixture of Cudbear and Caramel, 
intended as a coloring agent when a brownish-red tint or 
color is to be reproduced. 

PiMPiNELL^ (Pimpinella, Ph. Ger.). — Each fluidrachm (4 Cc), 
represents about 10 grains (0.6) Pimpinella Root. 

Rhei Aquosa (Rhubarb, Aqueous, Ph. Ger.). — Each fluid- 
drachm (4 Cc.) represents about 5|- grains (0.4) of Rhu- 
barb, with alkalies, flavored with Cinnamon. 

Rhei et Gentians. — Each fluidrachm (4 Cc.) represents 5 
grains (0.3) of Rhubarb and I grain (0.06) of Gentian. 

Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.). — Each fluidrachm 
(4 Cc.) represents about 5 grains (0.3) Rhubarb, with Bitter 
Orange and Cardamom, in Sweet Sherry Wine. 

Saponis Viridis Composita. — A solution of about 15 per 
cent, of Green Soap and 2 per cent, of Oil of Cade. 

Tincture ^there^ (Ethereal Tinctures). — The drug, prop- 
erly comminuted, troy ounces 2 (60 Gm.) ; Stronger Ether, 
I volume ; Alcohol, 2 volumes ; enough to make fluid- 



92 A TEXT-BOOK OF MA TREIA MEDICA. 

Tinctura — 

ounces i6 (473 Cc). A general formula for the prepara- 
tion of Ethereal Tinctures of Belladonna, Castor, DigitaHs, 
Lobeha, Valerian, and other drugs. Official in several 
European pharmacopoeias, and sometimes prescribed by 
foreign physicians. 

ToLUTANA SoLUBiLis (Tolu, Soluble). — A so-called soluble 
essence of Tolu, for flavoring. 

Vanillini Composita. — A solution of Vanillin and Coumarin, 
intended for flavoring. 

Zedoari^ Amara (Zedoary Comp.). — Similar to, but not 
identical with, the Tinctura Carminativa, Wedelii, etc., for- 
merly official in some Continental pharmacopoeias. 

Each fluidrachm (4 Cc.) represents 15 grains (i Gm.) of 
Zedoary, 7-I- grains (0.5) of Aloes, and 3f grains (0.25), each, 
of Rhubarb, Gentian, White Agaric, and Saffron. 

EXTRACTA FLUIDA— FLUID EXTRACTS. 

Fluid Extracts may be defined as a class of concentrated 
tinctures of such strength as to represent the drug, volume for 
weight. 

The fluid extracts of the U. S. P. previous to 1880 represented 
I grain of drug in i minim, or i troy ounce in i fluidounce. In 
the U. S. P. of 1880 the standard adopted was i Gm. in i Cc, and 
this strength has been retained as the standard of the U. S. P. 1 890. 

Fluid extracts are made by pei^colation, mace^'ation, or digestion. 
Except on a large scale or by fractional percolation, they cannot 
be prepared by simple percolation without evaporation to concen- 
trate the percolate to the required measure. 

Fractional percolation or repercolation, or simultaneous frac- 
tional percolation, by employment of which the use of heat for 
concentrating the percolate is avoided, may be used to advantage 
when the quantity operated upon is sufficiently large to warrant 
the greater time and attention required. 

The following is the process chiefly employed : 

In proceeding to percolate 100 Gm. of the drug, according to 
directions, the first 80 to 90 Cc. are reserved, and percolation con- 
tinued until the exhaustion is completed. The weak percolate is 
evaporated to a soft extract (the alcohol being recovered) and dis- 
solved in the reserved percolate. Sufficient menstruum is then 
added to make the product measure 100 Cc. 



EXTRACTIVE PREPARATIONS. 93 

Average Dose. 
Official Name of Drug. Part. Cc. Minims. 

Extractum Fluidum — 

Aconiti Aconitum Napellus Tuber . . . 0.06 i 

Apocyni Apocynum Cannabinum Root . . . , i. 15 

Arnicse Radicis . . Arnica montana Root .... 0.5 8 

Aromaticum .... Pulvis Aromaticus 0.5 8 

Asclepiadis .... Asclepias tuberosa Root .... 2. 30 

Aspidospermatis . . Aspidosperma Quebracho-bianco . Bark ... 2. 30 

Aurantii Amari . . Citrus vulgaris Rind. ... I. 15 

Belladonna Radicis . Atropa Belladonna Root .... 0.2 3 

Buchu Barosma betulina Leaves ... 2. 30 

Calami Acorus Calamus Rhizome . . 2. 30 

Calumb^ Jateorrhiza palmata Root .... 2. 30 

Cannabis Indicae . , Cannabis sativa Fl. Tops . . 0.6 10 

Capsici Capsicum fastigiatum Fruit .... 0.2 3 

Castanet Castanea dentata Leaves ... 4. 60 

Chimaphilge .... Chimaphilaumbellata Leaves ... 2. 30 

Chiratse Svvertia Chirata Plant .... 2. 30 

Cimicifugse .... Cimicifuga racemosa Rhizome . . 2. 30 

Cinchonge Cinchona Calisaya Bark .... 2. 30 

Cocae Erythroxylon Coca Leaves ... 2. 30 

Colchici Radicis . . Colchicum autumnale Corm . . . 0.3 5 

Colchici Seminis . . Colchicum autumnale ..... Seed .... 0.3 5 

Conii Conium maculatum Fruit .... 0.25 4 

Convallarias .... Convallaria majalis Rhizome . . 0.6 lO 

Cubebae Piper Cubeba Fruit .... 2. 30 

Cusso Hagenia Abyssinica Inflor. ... 4, 60 

Cypripedii .... Cypripedium pubescens Rhizome . . I. 15 

Digitalis Digitalis purpurea Leaves ... o. 1 2 2 

Dulcamarge .... Solanum Dulcamara Branches . , 2. 30 

Ergotae Claviceps Purpurea Sclerotium .2. 30 

Eriodictyi Eriodictyon glutinosum Leaves ... 2. 30 

Eucalypti Eucalyptus globulus Leaves . . . i. 15 

Eupatorii Eupalorium perfoliatum Herb .... 2. 30 

Frangulae Rhamnus Frangula Bark .... 4. 60 

Gelsemii Gelsemium sempervirens .... Rhizome . . 0.2 3 

Gentianae Gentiana lutea Root .... 1.3 20 

Geranii Geranium maculatum Rhizome . . 2. 30 

Glycyrrhizae .... Glycyrrhiza glabra - . Root .... 4. 60 

Gossypii Radicis . . Gossypium herbaceum Root Bark . 2. 30 

Grindeliae GrindeUa robusta Leaves ... 2. 30 

Guaranae Paullinia Cupana Seeds ... 4. 60 

Hamamelidis , , . Hamamelis Virginiana Leaves ... 2. 30 

Hydrastis Hydrastis Canadensis Rhizome . . 2. 30 

Hyoscyami .... Hyoscyamus niger Herb ... 0.3 5 

Ipecacuanhae . . . Cephaelis Ipecacuanha Root .... 0.06-2, 1-30 

Iridis Iris versicolor Rhizome . . I. 15 

Krameriae Krameria triandra Root .... 2. 30 

Lappae Arctium Lappa Root .... 2. 30 

Leptandrse .... Veronica Virginica Rhizome . . 2. 30 



94 A TEXT-BOOK OF MATERIA MEDICA. 

Average Dosi 

I « , j^ 

Official Name Drug. Part. Cc. Minitus. 

Extractum Fluidum — 

Lobeliae Lobelia inflata .... ..... Herb , . , , 0.6 10 

Lupulinse Humulus Lupulus Powder . . . 0.6 10 

Matico Piper Angustifolium Leaves ... 4. 60 

Menispermi .... Menispermum Canadense .... Rhizome . . 2. 30 

Mezerii Daphne Mezereum Bark .... 0,3 5 

Nucis Vomicae . . . Strychnos Nux-vomica Seed .... 0.2 3 

Pareirae Chondodendrum tomentosum . . . Root .... 2. 30 

Phytolaccse Radicis . Phytolacca decandra Root .... 0.5 8 

Pilocarpi Pilocarpus Selloanus (Jaborandi) . Leaves ... 2. 30 

Podophylli .... Podophyllum peltatum Rhizome . . 0.6 10 

Pruni Virginianse . Prunus serolina Bark .... 2. 30 

Quassiae Picrsena excelsa Wood ... 0.5 8 

Rhamni Purshianae . (Cascara sagrada) Bark .... 2. 30 

Rhei Rheum officinale Root , . . . i. 15 

Rhois Glabrae . . . Rhus glabra Leaves ... 2. 30 

Rosae Rosa Gallica Petals ... 2. 30 

Rubi . Rubus villosus . . Root Bark . 2. 30 

Rumicis Rumex crispus Root .... 4. 60 

Sabinae Juniperus Sabina Tops .... 0.5 8 

Sanguinariae .... Sanguinaria Canadensis Rhizome . . 0.3 5 

Sarsaparillae .... Smilax officinalis, etc Root .... 4. 60 

' Sarsaparilla, 75 "j 
Sarsaparillae Com- Qlycyrrhiza, 12 I 

" ' Sassafras, 10 ■^ 

Mezereum, 3 

Scillae Urginea maritima Bulb .... 0.3 5 

Scoparii Cytisus Scoparius Tops . , . . i. 15 

Scutellariae .... Scutellaria lateriflora Herb ... 2. 30 

Senegae Polygala Senega Root .... 0.3 5 

Sennae Cassia acutifolia and Angust. . . Leaves ... 4, 60 

Serpentariae .... Aristolochia Serpentaria Rhizome . . i. 15 

Spigehae Spigelia Marilandica Rhizome . . 2. 30 

Stillingiae Stillingia sylvatica Root .... 2. 30 

Stramonii Seminis . Datura Stramonium Seed .... 0.2 3 

Taraxaci Taraxacum officinale Root .... 4. 60 

Tritici Agropyrum repens Rhizome . . 4. 60 

Uvae Ursi Arctostaphylos Uva Ursi .... Leaves ... 2. 30 

Valerianae Valeriana officinalis Rhizome . . 2. 30 

Veratri Viridis . . . Veratrum viride Rhizome . . 0.12 2 

Viburni Opuli . . . (Cramp bark) Bark .... 2. 30 

Viburni Prunifolii . (Black haw^) Bark .... 2. 30 

Xanthoxyli .... Xanthoxylum Americanum . . . Bark . . . , i. 15 

Zingiberis Zingiber officinale Rhizome . . 0.6 lO 

Unofficial Fluid Extracts of the National Fomnulary. 

Unless otherwise indicated, the dose of the following Fluid Ex- 
tracts is from \ to i fluidrachm (2 to 4 Cc.) : 



EXTRACTIVE PREPARATIONS. 95 

Extractum Fluidum — 

Adonidis. — Root of Adonis vernalis L. (Bird's Eye). 
Aletridis. — Rhizome of Aletris farinosa L. (Stargrass). 
Angelica Radicis. — Root of Archangelica L. (Angelica). 
Apii Graveolentis. — Seed of Apium graveolens L. (Celery). 
AralitE Racemos.e. — Root of Aralia racemosa L. (American 

Spikenard). 
Arnica Florum. — Flower heads of Arnica montana L. (Ar- 
nica). 
Berberidis Vulgaris. — Bark of the root of Berberis vulgaris 

L. (Barberry). 
BoLDi. — Leaves of Peumus Boldus Molina (Boldo). 
BucHU CoMPOSiTUM. — A combination of Buchu, 10; Cubeb, 

2 ; Juniper, 2 ; Uva Ursi, 2 parts. 
Calendula. — Flowering herb of Calendula officinalis L. 

(Marigold). 
Camellle:. — Leaves of Camellia Thea Link (Tea). The best 

quality of commercial black tea, " Formosa Oolong," to be 

employed for this preparation. 
Caulophylli. — Rhizome and rootlets of Caulophyllum thahc- 

troides Mich. (Blue Cohosh). 
Coffe.e: Viridis. — Unroasted seeds of Coffea Arabica L. 
CoFFE.E TosT.E. — Roastcd seeds of Coffea Arabica L. 

The N. F. recommends equal portions of Java and Mocha 

to be employed in preparing the Fluid Extracts of Coffee. 
CoNVALLARi^ Florum. — Flowers of Convallaria majalis L. 

(Lily of the Valley). 
CoPTis. — Rhizome of Coptis trifolia Salisb. (Goldthread). 
CoRNUS CiRCiNAT.E. — Bark of Cornus circinata L'Her. (Green 

Osier.) 
Cornus Florid.e (U. S. P. 1880). — Dogwood Bark. 
CoRYDALis. — Tubers of Dicentra Canadensis De C. (Turkey 

Corn). 
CoTO. — Coto bark, undetermined tree. Dose, from 5 to 15 

minims (0.3 to I Cc). 
Fuel. — Thalus of Fucus vesiculosus L. (Bladder-wrack). 
Helianthemi. — Herb of Helianthemum Canadense Mich. 

(Frost-wort). 
HuMULi. — Strobiles of Humulus lupulus L. (Hops). 
Hydrangea. — Root of Hydrangea arborescens L. (Seven 

Barks). 



96 A TEXT-BOOK OF MATERIA MEDICA. 

Extractum Fluidum — 

Jalaps. — Tuber of Exogonium purga Benth. (Jalap). Dose,, 
from 15 to 20 minims (i to 1.3 Cc). 

JuGLANDis. — Bark of the root of Juglans cinerea L. (Butternut). 

JuNiPERi. — Fruit of Juniperus communis L. 

Kava. — Root of Piper methysticum Forster (Kava; Kava- 
Kava). 

Lactucarii (U. S. p. 1880). — Insp. juice of Lactuca virosa L. 

Malti. — (Fluid Extract of Malt). 

Menyanthis. — Leaves of Menyanthes trifoliata L. (Buckbean ; 
Trifolium fibrinum, Ph. G.). 

Mezerei (U. S. p. 1880). — Bark of Daphne mezereum L. 
Dose, from 5 to 10 minims (0.3-0.6 Cc). 

Petroselini Radicis. — Root of Petroselinum sativum Hoff- 
man (Parsley). 

QuiLLAj^. — Bark of Quillaja Saponaria Molina (Soap Bark). 

Rhamni Purshian^ Aromaticum. — Cascara Sagrada de- 
prived of its bitter taste. 

Rhei Aromaticum. — A combination of Rhubarb, Cinnamon^ 
Cloves, and Nutmeg. 

Senn^ Deodoratum (Aqueous Fluid Extract of Senna). — 
This preparation is free from the objectionable " griping " 
qualities of the ordinary fluid extract. 

Sterculi^. — Seeds of Sterculia acuminata R. Brown (Cola 
or Kola). 

Stilllingi^ Compositum (Stillingia Comp.). — Stillingia, Cory- 
dalis, each, 4 parts ; Iris, Sambucus, Chimaphila, each, 2 
parts ; Coriander, Xanthoxylum Berries, each, i part. 

Trillii. — Rhizome of Trillium erectum L. (Bethroot). 

Turners. — Leaves of Turnera microphylla De C. (Damiana). 

Urtic^. — Root of Urtica dioica L. (Nettle). 

Verbasci. — Leaves (and flowers) of Verbascum Thapsus L. 

Verbena. — Root of Verbena hastata L. (Vervain). 

Ze^. — Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays 
L. (Indian Corn). 
As a rule, a Fluid Extract is made of every vegetable drug 
which is a part of a plant. There are altogether about 500 Fluid 
Extracts. Relatively, the Fluid Extracts are not as strong as the 
Tinctures, but they have the great advantage over the latter in that 
they are more concentrated and of uniform drug-strength— the 
strength of the drug. 



EXTRACTIVE PREPARATIONS. 97 

EXTRACT A— EXTRACTS. 
Extracts— or '' solid " extracts as they are termed, to distinguish 
them from fluid extracts — are the soluble active principles of vege- 
table drugs, concentrated by evaporation to a soft solid or a plastic 
mass of pilular consistence. 

The strength of an extract depends upon the amount of the 
crude 'drug it represents. Hence, the smaller the percentage of 
extract obtained from a drug, the greater the relative strength 
of the extract, provided that the drug be exhausted with menstrua 
adapted to secure all the active principles in this form. 

The yield of extract is influenced by the character of the men- 
struum employed : with a few drugs like Rhubarb the quality of the 
drug sometimes governs the yield, the least percentage being 
obtained from the poorest quality. 

As a general rule, the more aqueous the menstrua, the greater 
the yield of extract ; conversely, the more alcoholic the menstrua, 
the smaller the yield of extract. To obtain the extracts, therefore, 
of official strength it is necessary to use official menstrua in the 
extraction. 

Thus the extracts of different drugs are as many times stronger 
than the drug as the quotient obtained by dividing the drug at 
100 by the percentage yield. For example : Podophyllum yields 
lO per cent, of extract ; then lOO ^ lo = lO ; that is, the extract is 
ten times as strong as the drug and the fluid extract, or o.i of the 
extract represents i Gm. of the drug or i Cc. of the fluid extract. 
The drug-strengths of the official Extracts, calculated by this 
method, as well as their relative doses based upon the amounts of 
drug they represent, are exhibited in the table given on page 96. 

The 33 official Extracts are made by extraction with alcoholic 
menstrua or with water, sometimes by the addition of acid or 
alkali. 

There are four extracts made by the addition of powders to 
the extracts, including the Extract of Colocynth, the Compound 
Extract of Colocynth, and the assayed extracts, made by the addi- 
tion of Sugar of Milk to represent a certain alkaloidal strength in 
the powdered extract. 

Extractum Nucis Vomicae contains 15 per cent, of total alka- 
loids ; I Gm. represents about 10 Gm. of drug. 

Extractum Opii contains 18 per cent, of crystallized morphine; 
I Gm. represents 2 Gm. of normal moist opium, about 1.4 Opii 
pulvis (14 per cent, morphine). 
7 



98 



A TEXT-BOOK OF MATERIA MEDICA. 



Table showing the Dntg-strengtJi and the Average Doses of the 

Official Extracts. 



Extractum. 



Part. 



Aconiti 

Aloes (aqueous) .... 

Arnicse 

Belladonnse Fol. Alcoholic 
Cannabis Indicse .... 

Cimicifugae 

Cinchonae (Calisaya) . . 
Colchici (acetic) .... 
Colocynthidis (powder) 



Root 



Colocynthidis Com- 
positum (powder) 



Conii (acetic) . . . 

Digitalis 

Ergotae 

Euonymi 

Gentianae (aqueous) 
Glycyrrhizse (stick) , 
Glycyrrhizae Purum (ammon 
Haematoxyli (aqueous) 

Hyoscyami 

Iridis 

Jalapse 

Juglandis ... 
Krameriae (aqueous) . 
Leptandrse . ... 
Nucis Vomicae (powder 
Opii (powder) .... 
Physostigmatis .... 

Podophylli 

Quassiae (aqueous) . . 

Rhei 

Stramonii 

Taraxaci (aqueous) . . 
Uvae Ursi 



Root . 

Leaves 

Herb . 

Rhizome 

Bark 

Corm 

Fruit 
[Ext. Colocynth, i6; 
Cardamom, 6 ; Aloes, 
50; Soap,Scammony, 
each, 14. 

Fruit . 

Leaves 

Sclerot 

Bark . 

Root . 

Root . 

Root . 

Logwood 

Herb 

Rhizome 

Tuber 

Bark 

Root 

Root 

Seed 



Calabar bean 
Rhizome 
Wood 
Root . 
Seed . 
Root . 
Leaves 



Parts 
of Drug 

in 
I part of 
Extract. Grains. 



Dose of Drug. 



5 
2 

5 
5 

10 

10 

6 

3 
6 



4 
4 
5 
5 
4 
3 
3 
4 
6 

7 
6 
6 
5 

5i 
10 
ji 

20 
10 
25 
3 
10 

3 
3 



10 
10 

3 

10 

10 

30 

5 

3 



4 
2 

30 
30 
20 
30 
60 
10 
6 
7 

15 
15 
15 
15 
3 
I 

10 
5 

30 
3 

30 

30 



Gm. 



.06 

.65 

.65 

.2 

.65 

.65 

•3 
.2 



•25 
.12 

2. 
2. 

13 

2, 

4- 

.65 

■4 

■5 
I. 
I. 
I. 
I. 

.2 

.06 

.06 

.65 

•3 



Dose of Extract. 



Grains. Gm 



6 

5 

10 
20 

2i 
I 



.012 

•32 

.12 

•03 
.06 
.06 

•3 
.12 

•03 



.06 
•03 

.4 
.4 
•3 
.65 

1-3 

•15 

.06 

.06 

.2 

.2 

.2 

.2 

.02 

.04 

.01 

.06 

.06 

.65 

•15 

.65 
.65 



ABSTRACTA— ABSTRACTS. 

A class of powdered extracts, prepared from the extracts by the 
addition of sufficient Milk Sugar to make the product represent 
one-half its weight of the crude drug, was official in the U. S. P. 
VI. (1880) under the title of Abstracts. 

The Abstracts have a uniform relation to the drug — viz. / grain 
represents 2 grains of the drug, just as the fluid extracts have the 
uniform relation of representing the drug measure for weight. 

In preparing an abstract the drug is exhausted, the extract 
obtained incorporated with its weight of Milk Sugar, the mixture 



EXTRACTIVE PREPARATIONS. 99 

powdered, and enough Milk Sugar added to bring the product to 
one-half the weight of the drug employed. Abstracts must be pre- 
served in small, perfectly dry, and well-corked vials in a dry and 
cool place. 

Their uniformity alone should have favored the employment of 
Abstracts in preference to the Extracts, since they do not share the 
variability in strength of the extracts, the dose of the Abstract beiiig 
exactly one-half that of the crude drug or Fluid Extract. This 
advantage was offset by the disadvantage that Abstracts are more 
bulky, and caused their deletion in the U. S. P. 1890. The Ab- 
stracts are therefore unofficial. 

The official Extracts- of Jalap and of Nux Vomica have su- 
perceded the abstracts of these respective drugs in a more con- 
centrated and equally convenient form. Of the remaining nine 
Abstracts formerly official, Aconite, Belladonna, Conium, Digitalis, 
Hyoscyamus (Ignatia, superceded by Nux Vomica), Podophyllum, 
Senega, and Valerian, the five first mentioned, commonly but 
erroneously called the " narcotic extracts," may be prepared, in 
the powdered form, of such strength as to represent the same 
drug-strength as their respective official " soHd extracts." 



ExTRACTUM Ferri Pomatum, N. F. — Fcrri Malas Crudus (Fer- 

rated Extract of Apples, Ph. Ger.). 
ExTRACTUM Glycyrrhiz^ Depuratum, N. F. — Succus Liqui- 

ritiae, Ph. Ger. (Purified Extract of Liquorice). 

OLEORESIN.^— OLEORESINS. 

To natural Oleoresins, derived as plant-exudations, belong the 
Turpentines and the Pitches. From similar exudations are ob- 
tained the Gum Resins, mixtures of Gum and Resins and sometimes 
Volatile Oils ; also the Balsams, which are Resins or Oleoresins 
associated with Benzoic or Cinnamic Acid. These are treated 
under their respective Drugs. 

The pharmaceutical Oleoresins are semi-liquid extracts, obtained 
by exhausting oleoresinous drugs with Ether. 

Ether extracts fixed and volatile oils from drugs, as well as resin; 
these principles constitute therefore the oleoresins, which some- 
times also contain other active matter in solution or suspension. 

The menstruum (Ether), being easily volatilized, is recovered by 
distillation ; it is sometimes superseded by Alcohol, which yields an 
extract very similar to that obtained with ether. 



lOO A TEXT-BOOK OF MA TERIA MEDICA. 

The six following are official : 

Dose. 
Oleoresina — , . , 

Aspidii ; separates in two layers, 

to be mixed when used . . . 1-2 drachms. 4.-8. 
Capsici ; separates fat, used only as 

corrective ^^^ " 6 grain. 0.01-0.005 

Cubebae ; separates wax .... 1-2 grains. 0.06-0.1 

LupuHnae 2-3 grains. 0.1-0.2 

Piperis ; separates piperine, to be 

rejected 1-2 grains. 0.08-0.1 

Zingiberis -^-J- grain. 0.02-0.01 

RESINS— RESINS. 

The official Resins may be divided into the (i) Natural Resins, 
(2) Resins obtained from Oleoresins by separating the Volatile Oil 
by distillation, and (3) the Pharmaceutical Resins, prepared by pre- 
cipitation. 

When a concentrated tincture of a resinous drug is poured into a 
large quantity of cold water, the resinous matter becomes insoluble 
and is precipitated ; this, after being washed, dried, and sometimes 
powdered, is termed a resin. 

Resins are usually soluble in alkalies and insoluble in acids 
(dilute) ; for this reason the water used for precipitation is some- 
times rendered slightly acid to favor the separation. 

The three following are official : 

Per cent, yield 

from Drug. Dose. Rep. Drug. 
Resina — , * v , ^- ^ 

Jalapae 15 3 grains 0.2 20 grains 1.3. 

Podophylli 5 \ grain 0.03 10 grains 0.6. 

Scammonii 65 3 grains 0.2 5 grains 0.3. 

Resina and Resina Copaibae are obtained as residue in the dis- 
tillation of the respective Oleoresins, Turpentine and Copaiba. 
The natural Resins are obtained as exudates — e. g. R. Guaiaci. 

The terms resin, resinoid, and concentration are also applied to a 
class of preparations used by eclectic physicians, prepared by this 
general process with some modifications. (See CJ. S. and Am. Disp.) 

They are named after their respective Drugs with the ending in, 
as in Glucosides, and must not be confused with the latter. While 
the Glucosides are usually the active medicinal constituents repre- 
senting the drug, the resinoids, with the exception of those made 



SOLID MIXTURES FOR INTERNAL USE. lor 

from drugs whose active principles are resins, such as Cimicifuga 
and Podophyllum, are more or less inert, unreliable mixtures, too 
indefinite in their composition and strength for medicinal use. 



SOLID MIXTURES FOR INTERNAL USE. 

Mixtures of Solids for internal use embrace the following 
classes of preparations : Powders, Effervescent Salts, Confections, 
Troches, Masses, and Pills. 

Powders are substances reduced to a fine pulverulent condition 
to favor their administration and solution or absorption. A powder 
may be simple, such as a powdered drug, Pulvis opii, or a pow- 
dered salt — i. e. QiiinincE sulphas ; or it may be compound, a mix- 
ture of several substances. 

Sparingly soluble substances, when finely powdered (impalpable) 
and thoroughly mixed by trituration in a mortar with some inert 
powder (diluent) such as Milk Sugar, are rendered more soluble, 
since a greater surface is exposed to the solvent action of the 
liquids of the body, and prompter and fuller effects are obtained. 
The potency of calomel, of the resins, and of alkaloids is in this 
way considerably increased within certain limits, but not to the 
unreasonable extent advocated by Homoeopathic pharmacy, in 
which this process is carried to a reductio ad absurdum. It is an 
excellent and convenient method for dispensing and administering 
the more potent agents, such as arsenous acid, mercury com- 
pounds, and the alkaloids. Substances triturated in this way have 
been called Triturations, for whose preparation the U. S. P. gives a 
general formula : 

Take of the substance, for example, Elaterin . . . i Gm 
Milk Sugar, in fine powder 9 Gm. 

First thoroughly triturate the medicinal substance (Elaterin) 
with an equal weight of Milk Sugar, then add the remainder of the 
Milk Sugar, and mix thoroughly by trituration (for about ten 
minutes). 

Unless otherwise specified, triturations should be of the official 
strength — i. e. 10 per cent, of the drug. 

By the addition of about an equal weight of Alcohol to the 
triturate it becomes a soft mass, which, after being moulded into 



I02 A TEXT-BOOK OF MATERIA MEDICA. 

disks of about i grain (0.06) each, after the evaporation of the 
Alcohol, furnishes the so-called Tablet Triturates. These afford 
a convenient method of medication for such substances as are 
adapted to trituration, which is, however, confined, as indicated, 
to a comparatively limited number of agents. To represent in the 
form of these tablets every kind of medicinal agent of volatile cha- 
racter, or drugs otherwise susceptible to change through the inevi- 
table exposure to the atmosphere to which every such mixture is 
liable, is simply to invite error in practice. These tablets, more- 
over, with certain chemical substances, undergo chemical changes 
which render them entirely insoluble, and thus practically inert. 
In order to be effective and otherwise reliable, they should be pre- 
pared extemporaneously by the pharmacist, in order to ensure 
their solubility. 

They should always be dissolved in a little water before they 
are administered. 

When it is desired to obtain a mild and prolonged local effect 
of a medicinal agent in the mouth or throat, the substance is made 
into a soft mass {confection) with a diluent and excipient, Sugar and 
Mucilage, and flavor, and formed into round or oval-shaped disks, 
weighing from 8 to 30 grains (^to 2 Gm.), called variously Lozenges, 
Troches, Tablets, and Pastils. 

Troches. — When these are allowed to dissolve slowly in the 
mouth the diluent serves as a vehicle for the medicinal agent, and 
a gradual prolonged effect is obtained upon the mucous surfaces. 
This form of medication is adapted only to astringents, antacids, 
expectorants, and stomachics consisting of substances not especi- 
ally disagreeable to the palate. 

Tablets, or Lozenges, are not intended to be swallowed, nor 
adapted to exceedingly volatile, caustic, irritant, or otherwise un- 
palatable substances. For ingestion, medicinal agents should be 
made into a Mass (inassa) with an excipient, and formed into small 
spheres, or balls, as a rule not over 5 grains (0.3) in weight, 
to be swallowed and slowly dissolved in the stomach or intestines. 
Such preparations are the so-called Pills {Pilules, from pila, ball). 

PULVERES— POWDERS. 

The nine official Powders are impalpable mixtures of one or 
more active drugs, usually with some nearly inert substance, such 
as Sugar, as a diluent, and Aromatics. 

They are made by trituration. 



SOLID MIXTURES FOR INTERNAL USE. 103 

Pulvis — ^'^^- ^^^ ^00. 

Antimonialis (James') . calc. phos. (yj \ antimon. oxide 33. 

Aromaticus .... cinnamon (Ceylon), ginger, each 35. 

cardamom (seed), nutmeg, each 15. 

Cretae Compositus . acacia p. 20; sugar 50; prep, chalk 30. 

Glycyrrhizse Compositus . . . senna 18; glycyrrhiza 24. 

fennel oil 0.4; sulphur, washed, 8; sugar 50. 

Ipecacuanhae et Opii . . . ipecac, opium pulv., each 10. 

(Dover's Powder) sugar of milk 80. 

Jalapae Compositus .... potass, bitartrate 65; jalap 35. 

Rhei Compositus . magnesia 65 ; ginger 10; rhubarb 25. 

In 60 grains. 

Pulv. Morphinse Compositus . . camphor 10; morphine 

(Tulley's Powder) sulph. i. 

calcium carb., precip. ; glycyrrhiza p., each 20. 

For 12 pow . ; in each, grains. 

Effervescens Compositus . (Seidlitz Powder) 

potassium and sodium tartrate 93 Gm. 120 
sodium bicarbonate 31 Gm. 40 

acid tartaric. 27 Gm. 3^; 

Many methods are in use for the purpose of disguising the taste 
of disagreeable remedies in the powder form. Of these the most 
elegant and effective method is that of enclosing the powder in a 
cachet or wafer. Originally wafers were made of starch-paste in 
thin sheets ; a piece about 0.5 dcm. (2 inches) square, immersed 
in water for a minute, being placed in a spoon, the powder poured 
into it, and then enwrapped by folding up the edges and swallowed 
with a little water. The cachets or " konseals " are wafer-disks 
consisting of two concentric halves, one of which is filled with the 
powder, and the other half attached by moistening the edge and 
pressing the edges together by means of various devices. These 
cachets are of three sizes, the largest holding 5 grains (0.3) Quinine 
Sulphate. After one minute's immersion in water they can be 
swallowed without any effort. 

Unofficial Powders of the N. F. 
Pulvis — 

AcACL^ Compositus (Pulvis Gummosus, Ph. Ger.). 

AcETANiLiDi Compositus. — Containing 50 per cent. Acetan- 



I04 A TEXT-BOOK OF MATERIA MEDIC A. 

Pulvis — 

ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium 
Bicarbonate. 

Aloes et Canell/E (Hiera Picra). 

AMYGDALiE CoMPOSiTus (Almonds Comp.) — A mixture of 
Sweet Almond, Sugar, and Acacia, in fine powder; i8o 
grains (lo Gm.), triturated with Water, yield about 4 fluid- 
ounces (119 Cc.) of Emulsum Amygdalae. 

Anticatarrhalis (Catarrh Snuff) — Hydrochlorate of Mor- 
phine, I part; Acacia, 60 parts ; Subnitrate of Bismuth, 180 
parts, in fine powder. 

Catechu Compositus (Compound Powder of Catechu, Ph. Br.). 
— Catechu, 4 parts ; Kino, 2 parts ; Krameria, 2 parts ; 
Cinnamon, i part ; Nutmeg, i part. 

Cretze Aromaticus. — A mixture of Cinnamon, Saffron, Nut- 
meg, Cloves, Cardamon, prepared Chalk, and Sugar. 

Cret^ Aromaticus cum Opio. — Aromatic Powder of Chalk, 
with I grain (0.06) of powdered Opium, in 40 grains (1.5) of 
the mixture. Official in the Ph. Br. 

Hydrargyri Chloridi Mitis et Jalaps (Calomel and 
Jalap). — A mixture of Mild Chloride of Mercury, 10 grains 
(0.6), and Jalap, 20 grains (1.3). 

When " Calomel and Jalap " is prescribed for an adult, without any speciti- 
cation of quantities, the N. F. recommends that the above mixture be dispensed 
as one dose. 

loDOFORMi Compositus (Iodoform and NaphthaHn). — A mixture 
of Iodoform, 2 parts ; Boric Acid, 3 parts ; NaphthaHn, 5 
parts ; with Oil of Bergamot, in fine powder. 

This powder is used in many cases where a diluted preparation of Iodo- 
form, for external purposes, is desired. The odor is masked both by the Oil 
of Bergamot and by the NaphthaHn. 

Kino Compositus. — A mixture of Kino and Cinnamon, with i 
grain (0.06) of Powdered Opium in each 20 grains (1.3). 

Myric^ Compositus (Composition Powder). — A mixture of 
Bayberry, Ginger, Capsicum, and Cloves. 

Pancreaticus Compositus (Peptonizing Powder). — A mixture 
of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 
25 grains will peptonize i pint of milk. 

Pepsini Compositus (Pulvis Digestivus). — A mixture of Pep- 
sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, 
with Milk Sugar to represent the gastric juice. 



SOLID MIXTURES FOR INTERNAL USE. 105 

Pulvis — 

Rhei et Magnesia Anisatus (Compound Anise Powder.) — 
A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. 

Talci Salicylicus (Salicylated Powder of Talcum). — A mix- 
ture of Talcum with 3 per cent. SalicyHc Acid and lO per 
cent. Boric Acid, in fine powder. 

Powders are usually directed to be divided into papers {cJiar- 
tulce) ; thus, for example, a formula for a prescription would be — 

]^ Hydrargyri Chloridi Mitis . . i. 

Sacchari Lactis 9. 

Misce cum trituratione et in chartulis No. x. divide. 

Encapsuling powders by filling them in gelatin capsules is a 
very convenient and elegant form of administration. No mixture 
which is desired to be given in the form oi powder^ however, should 
be made into a mass for facilitating the encapsuling process — 
a custom too frequently adopted. Many substances, especially 
Bismuth Subnitrate and Calomel, become exceedingly hard and 
quite insoluble when made into a mass. No dispenser should 
assume the prerogative of changing the form of medication pre- 
scribed. 

SALES EFFERVESCENTES EFFERVESCENT SALTS. 

These are granulated mixtures of Salts with Sugar and Sodium 
Bicarbonate and Tartaric Acid, which decompose when the Salt is 
dissolved in Water and furnish agreeable aerated draughts. 

The following are official, the strength indicated being that con- 
tained in 90 grains (6 Gm.), a heaped teaspoonful being the ordinary 
dose, dissolved in about 6 fluidounces (180 Cc.) of water: 

Caffeina Citrata Effervescens caffeine 0.06 

Lithii Citras Effervescens .... lithium citrate 0.06 

Magnesii Citras Effervescens . magnesium citrate i.o 

Potassii Citras Effervescens . . . potassium citrate 3.0 

Effervescent Salts {Granular), N. F. 

The strength given for these is the quantity contained in 90 
grains (6 Gm.), which represents about the quantity of these Salts 
contained in a heaped teaspoonful of ordinary size, the average 
dose. 



io6 A TEXT-BOOK OF MATERIA MEDICA. 

Ferri et Quinine Citras Effervescens, i grain (0.06) Citrate 
of Iron and Quinine. 

Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron^ 

PoTASSii Bromidum Effervescens, 20 grains (1.3) Potassium Bro- 
mide. 

PoTASSii Bromidum cum Caffeina, 10 grains (0.6) Potassium Bro- 
mide and J grain (0.06) Caffeine. 

Sal Carolinus Factitius Effervescens (Effervescent Carlsbad 
Salt, artificial). — A solution of about 87 grains (5.5) in 6 fluid- 
ounces (178 Cc.) of Water represents an equal volume of 
Carlsbad Water (Sprudel). 

Sal Kissingensis Factitius Effervescens (Effervescent Kissingen 
Salt, artificial). — A solution of about 80 grains (5 Gm.) in 6 fluid- 
ounces (178 Cc.) represents an equal volume of Kissingen 
Water (Rakoczy). 

Sal Vichyanus Factitius Effervescens (Effervescent Vichy 
Salt, artificial). — A solution of about 57 grains (4 Gm.) in 6 
fluidounces (178 Cc.) of Water represents an equal volume of 
Vichy Water (Grand Grille). 

Salts {Non-effcvvesceni). 

Sal Carolinus Factitius. — In two forms. Dry (Ph. Ger.) and 
Crystalline. A solution of about 16 grains (i Gm.) of the Dry 
(27 grains (1.8) of the Crystalline) in 6 fluidounces (178 Cc.) 
of Water represents an equal volume of Carlsbad Water 
(Sprudel). 

Sal Kissingensis Factitius. — A solution of about 24 grains (1.5) 
in 6 fluidounces (178 Cc.) of Water represents an equal volume 
of Kissingen Water (Rakoczy). 

Sal Vichyanus Factitius. — A solution of about 14 grains (i Gm.) 
in 7 fluidounces (207 Cc.) of Water represents an equal volume 
of Vichy Water (Grand Grille). 

CONFECTIONES— CONFECTIONS. 

Confections may be defined as flavored masses wherein the 
adhesive substance is Sugar in large proportions, serving as a 
vehicle for masking the taste of the drug. 

Confections, when made by beating a fresh drug, first reduced 
to pulp with sugar until of the proper consistence, are termed 
conserves. When made from powders or extracts they are called 
electuaries. 



SOLID MIXTURES FOR INTERNAL USE. 



107 



Only one representative of each class is official : 

Gm. in 100 Cc 

Confectio Rosae rose water i6, red rose 8. 

(Conserve of Rose) sugar 64, honey 12. 

c oil coriander 0.5, senna 10. 

Confectio Sennae . < cassia fistula 16, fig 12, tamarind 10. 
{Electuar. Sennce) I prune 7, sugar 55, water to 1 00. 

The Confection of Senna is a very agreeable laxative, especially 
adapted for constipation in women and children. It is exceedingly 
agreeable to the taste. 

TROCHISCI— TROCHES. 

Troches, or lozenges, are confections made into various forms 
and then dried. 

The vehicle or excipient consists of Powdered Gum Tragacanth 
or Sugar with flavoring — in some cases orange flower water, in 
others tolu, nutmeg, vanilla, etc. 

The active ingredients are mixed with the diluent or vehicle and 
made into a plastic mass with the particular excipient, Water or 
Syrup. The mass is rolled out to the requisite thickness, and the 
disks formed by cutting through it with a punch or troche-cutter. 
The troches are then dried by exposure. 

The size and weight of the troche are regulated by the thickness 
of the mass and the diameter of the cutter. 

The 15 official Troches vary in weight from Gm. 0.5 to 1.5. 



Trochisci — 

Acidi Tannici 

Ammonii Chloridi .... 
extract glycyrrhiza 

Catechu 

Cretae 25 

Cubebae .... oleoresin 

extract glycyrrhiza 

sassafras oil 

Ferri . . . ferric hydrate 

Glycyrrhiza et Opii 

ext. glycyrrhiza 
powd. opium 





ACT 


ivE Drug. 


Gm. in 


Gm. in 


Grains in 


100 


each 


each 




Troches. 


Troche. 


Troche 




6. 


0.06 


I 


Orange flor. 


10. 


O.I 


4 


Tolu. 


25- 


0.25 


4 




6. 


0.06 


I 


Orange flor. 


25. 


0.25 


4 


Nutmeg. 


4. 


0.04 


1 




25- 


0.25 


4 




I. 


0.0 1 


\ 




30. 


0.3 


T' 


Vanilla. 


15- 


0.15 


21 


Anise. 


0.5 


mg.5. 


h 





G7ti. in 

lOO 

Troches. 


Gm. in 

each 
Troche. 


Grains in 

each 

Troche. 


2. 

6 


0.02 
0.06 


i 

I 


Orange. 

flor. 


I. 
0.16 


O.OI 

mg. 16 


i 


Peppermint. 
Gaultheria. 


0.50 
30. 

3- 

20. 


" 5- 
0.3 
0.3 
0.2 


tV 
5 
i 


Lemon. 
Orange flor. 

Nutmeg. 


20. 


0.2 


i 


Ginger. 



108 A TEXT-BOOK- OF MATERIA MEDICA. 

Active Drug. 



Trochisci — 

Ipecacuanhge 2 

Krameriae .... extract 
Menthae Piperitae . . .oil 
Morphinae . morphine sulph. 
et Ipecac, powd. ipecac 
Potassii Chloratis .... 

Santonini 3 

Sodii Bicarbonatis .... 
Zingiberis . . tinct. ginger 

Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria 
may readily be prepared by saturating sugar lozenges with the 
respective essences or tinctures and permitting the alcohol to 
volatilize. 

MASS^— MASSES. 

Masses are plastic mixtures of pilular consistence. They are 
made by incorporating the drug with adhesive substances, by chem- 
ical reaction, and sometimes by both processes. 

The Masses are intended to be formed into pills whenever they 
are to be dispensed. They are therefore often called Pil, Pilulce, 
instead of Massa. There are only three official : 

Massa Copaibae .... water i, magnesia 6, copaiba 94. 

The Copaivic Acid combines with the magnesia, forming mag- 
nesium copaivate of pilular consistence. This is also known as 
'* solidified copaiba." 

Massa Ferri Carbonatis f sodium carb., ferrous sulph., each 100. 
(Vallet's Mass) I honey 38, sugar 25, syrup to 100. 

By double decomposition between the Ferrous Sulphate and 
Sodium Carbonate ferrous cai'bonate is formed, which is incorpo- 
rated with Honey and Sugar to prevent oxidation and to render 
the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil 
Blaudii) is preferable to this mass, as in the pill the ferrous car- 
bonate is better protected against oxidation. 

Massa Hydrargyri . glycyrrhiza 5, althaea 25, mercury 33. 
(Blue Mass) glycerin 3, honey of rose 34. 



SOLID MIXTURES FOR INTERNAL USE. 109 

The mercury is extinguished by trituration with the rose honey 

and glycerin and the powdered glycyrrhiza ; the other ingredients 

are then incorporated. The usual dose is from 5 to 10 grains 

(0.3-0.6). 

PILUL/E— PILLS. 

Pills are spherical, more or less soluble masses of medicinal 
substances rendered cohesive, plastic, and firm in consistence by the 
addition of some substance (usually inert) termed an excipient. 

The kind of excipient employed varies with the nature of the 
medicinal substance. As a general rule, such substances are chosen 
as give to the mass, with the smallest proportion, the greatest plas- 
ticity, and also best preserve the spherical shape of the pills. The 
excipient must also, unless the contrary be directed for especial 
purposes, be indifferent in character, to avoid change in the medic- 
inal agents. 

Soluble substances are rendered adhesive by the action of sol- 
vents, and require, according to their solubilities, the addition of 
some Hquid such as Water, Alcohol, Glycerin, etc. Others require 
the addition of adhesive substances, such as Syrup, Mucilage, Glu- 
cose, Glycerite of Starch or Tragacanth, etc. 

Drugs adapted for dispensing in the form of pills maybe divided 
as follows : 

(i) The official Masses, Extracts, and Scaled Salts. 

Masses and extracts, being of pilular consistence, require no 
addition except when hard or dry ; Water should then be incor- 
porated to restore them to their original form. Abstracts and 
powdered extracts are best made into a mass with Water. 

(2) Vegetable Powders in which the dose does not exceed five 
grains. 

With these adhesive excipients are indicated, such as Syrup, Mu- 
cilage, Glycerite of Tragacanth, and Glucose. The last mentioned 
answers the requirements better than most other substances. Con- 
fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- 
cum are also used when their color is not objectionable. 

(3) Salts not too dehquescent, and Alkaloids. 

Excipients for these must combine adhesive and absorbent quali- 
ties. They are first triturated with a dry powder — e. g. Althaea, 
Glycyrrhiza, or Milk Sugar — and then mixed with the adhesive 
substance — viz. Glucose or Glycerite of Starch or Tragacanth. 

No excipient must be used that will give to the mass a color 
different from that of the medicinal ingredients (the base). 



no A TEXT-BOOK OF MATERIA MEDIC A. 

(4) Volatile Oils and Oleoresins. 

The quantity of these when dispensed in pills being compara- 
tively large, it is necessary to add some light absorbent substance, 
such as Magnesia or Starch, to which is added the adhesive 
material. The practice of adding wax or resin to oils is not to be 
recommended except as a last resort, since they tend to render the 
pill insoluble. 

(5) Resins and Gum Resins. 

These form an adhesive mass by the addition of a little Alcohol, 
with which more bulky excipients, such as Soap, may be incorpo- 
rated to preserve the shape of the pill. 

(6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine 
Sulphates, etc. 

These are often prescribed in pill form in large doses, and it is 
therefore desirable to reduce their bulk. For this purpose dilute 
Sulphuric Acid or Tartaric Acid is added in small quantity, which 
acts as a solvent upon the salt, thereby converting it into a mass. 
This mass is incorporated with a little Glycerite of Starch, other- 
wise it soon loses its plasticity; it must therefore be rolled into 
pills as soon as formed. 

(7) Substances easily decomposed by organic matter. 
Potassium Permanganate and Silver Nitrate are quickly " re- 
duced " when incorporated with the excipients usually employed. 

These should be mixed with an inorganic diluent not affected 
by them, such as Kaolin, Pipe Clay, or Fullers' Earth, and made 
into a mass with Water, Petrolatum, Resin Cerate, etc. 

In order to disguise the bitter or otherwise disagreeable taste 
of pills, they are usually coated v/ith sugar or gelatin. These 
coated pills are often objectionable on account of the coating, or 
the pill itself, becoming quite insoluble. When a coated pill is 
desired, it should be freshly made and enclosed in a gelatin capsule 
of the smallest size. Pills may also be coated extemporaneously 
by rolling them on a piece of filter-paper saturated with Mucilage 
of Acacia, and then in powdered Milk Sugan 

Keratiii-coditQd pills are designed for solution in the duodenum, 
the pills being dipped in a solution of Keratin prepared from horn 
shavings treated with pepsin and hydrochloric acid. 

Concentric pills are made up of concentric layers of different 
ingredients, intended to dissolve and become active at various 
stages in their passage through the intestinal tract. 

The following 1 5 Pills are official : 



SOLID MIXTURES FOR INTERNAL USE. 



Ill 



Pilule. 



Aloes aloes purif., soap, each 

Aloes et Asafoetidse . aloes, asafoetida, soap, each 
Aloes et Ferri . . aloes, iron sulph., arom. powder 
Aloes et Mastiches (Dinner Pill) .... aloes 

mastic 
red rose 

Aloes et Myrrhae aloes 

myrrh 
arom. powder 

Antimonii Comp antimony, sulphurated 

(Plummer's Pills) mild mercurous chlor. 

guaiac 

Asafoetidae asafoetida 

Cathartics Comp ext. colocynth comp. 

mild mercurous chloride 

extract of jalapi 

gamboge 

CathartiCcC Vegetabiles . , > ext. colocynth comp. 

exts. hyoscyam., jalap, each 

ext. leptandra, res. podophyll. 

oil peppermint 

Ferri Carbonatis ferrous sulphate 

(Ferruginous, Chalybeate, Blaud's) potass, carb. 
sugar 4; tragac, althaea, each 

Ferri lodidii reduced iron 

iodine 

glycyn-h., sugar, each 

ext. glycyrrh., acacia, each 

Opii soap 2 ; opium pulv. 

Phosphori 2 phosphorus 

althaea, acacia, each 

Hhei soap 6; rhubarb 

Rhei Comp rhubarb 

aloes 

myrrh 

oil peppermint 



Gm. 

for 100. 



13 

9 

7 
13 

4 

3 
13 

6 

4 
4 
4 
8 
20 
8 
6 
3 

1-5 
6 

3 
1-5 

0.8 
16 
8 

I 
4 
5 
4 

6.5 
0.06 
6 
20 

13 
10 

6 

0.5 



grains. 



13 

9 
7 

13 
4 
3 

13 
6 

4 
4 
4 



1-5 

6 

3 

1.5 
0.8 
6 



6.5 
0.06 

20 

13 

10 

6 



Excipient. 



Glyc. water. 
Conf. rose. 

Water. 

Syrup. 



li Castor oil. 
3 Soap. 



Water. 



Water. 



Glyc. water. 



Water. 



Glyc. water. 
Water. 



Unofficial Pills of the National Formnlary. 
When a large number of pills are to be prepared in accordance 
with the given proportions, and the quantities of the ingredients 
are to be determined by multiplying with the number of pills re- 
quired, it is recommended that the nearest whole number, or near- 
est convenient fraction, in each case, be chosen. 

Pilulae— 

Ad Prandium (Dinner Pills). — When " Dinner Pills," under 
this or some other equivalent name, are prescribed without 
further specification, the National Formulary recommends 
that the Pilulae Aloes et Mastiches of the U. S. P., also 
called " Lady Webster's Dinner Pills," be dispensed. 

^ Coated with ethereal solution of Balsam Tolu. ^ Phosphorus dissolved in Chloroform. 



112 A TEXT-BOOK OF MATERIA MEDIC A. 

Pilulse— 

Of Other combinations bearing similar names or used for 
similar purposes, the following appear to be those most 
commonly in use : 

Chapman's Dinner Pill. — Aloes, Mastic, each, grains \\ 

(o.i); Ipecac, grain i (0.06); Oil of Fennel, grain \ (0.015). 

Coles Dinner Pill. — Aloes, Mass of Mercury, and Jalap, 

each, grains \\ (0.075); Ant. and Potas. Tartrate, grain J^ 

(0.0013). 

HaWs Dinner Pill. — Aloes, Ext. of Glycyrrhiza, Soap, 
and Molasses, each, grain i (0.06). 
Aloes et Podophylli Composite (Janeway's Pills). — Aloes, 
grain i (0.06) ; Resin Podophyllum, grain \ (0.03) ; Ext 
Bellad. Ale, Ext. Nux Vomica, each, grain \ (0.015). 
Aloini ComposittE. — Aloin, grain \ (0.03) ; Resin Podophyl- 
lum, grain \ (o.oi); Ext. Belladonna, grain \ (0.015). 
Aloini, Strychnine et Belladonna. — Aloin, grain \ (0.0 1 
Gm.) ; Strychnine, alkaloid, grain yi-^ (0.0005 Gm.) ; Alco- 
holic Extract of Belladonna, grain \ (0.008 Gm.). 
Aloini, Strychnine et Belladonna Composite. — Aloin, 
grain \ (0.012); Ext. Bellad. Ale, grain \ (0.008 Gm.) ; 
Strychnine, alkaloid, grain y^-g- (0.0005) 5 Ext. Rham. Pursh., 



(0.03). 



Anti dyspeptic A. — Strychnine, alkaloid, grain -^-^ (0.0014); 
Ipecac, Ext Bellad. Ale, each, grain -^-^ (0.006) ; Mass of 
Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). 

Antineuralgica. — I. Gross' Antinenralgic Pills: Quinine 
Sulphate, grains 2 (0.13); Morphine Sulphate, grain -^ 
(0.003) ; Strychnine, alkaloid, grain -^-^ (0.002) ; Arsenous 
Acid, grain ^V (0.003) i Ex. Aconite Leaves (U. S. P. 1870), 
grain \ (0.03). 

When " Antinenralgic Pills," or " Neuralgia Pills," with- 
out other specifications, are prescribed, it is recommended 
that the above preparation be dispensed. Sometimes the 
Morphine is directed to be omitted. 

2. Brown-Seqnard's Antineiiralgic (or Neuralgia) Pills: 
Extracts of Hyoscyamus and Conium, each, grain f (0.04) ; 
Extracts of Ignatia and Opium, each, grain \ (0.03) ; Ext. 
Aconite Leaves, grain \ (0.02) ; Ext. Stramonium, grain \ 
(0.01); Ext Indian Cannabis, grain \ (0.015); Ext Bellad. 
Ale, grain \ (0.0 1). 



SOLID MIXTURES FOR INTERNAL USE. 1 13 

Pilulae— 

ANTiPERiODiCiE (Wai'burg's Pills). — i. With Aloes : Aqueous 
Extract of Aloes, grain i (0.06) ; Rhubarb, grain J (0.03) ; 
Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- 
ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain J 
(0.008); Quinine Sulphate, grains if (0.085); Extract of 
Gentian, a sufficient quantity. 

2. Without Aloes : The same formula as above, with omis- 
sion of the Aqueous Extract of Aloes. These pills have 
been introduced for the purpose of facilitating the adminis- 
tration of Warburg's Tincture in a solid form. When 
" Warburg's Pills " or " Pills of Warburg's Tincture " are 
prescribed, without further specification, those containing 
Aloes are recommended to be dispensed — those without 
Aloes only when they are expressly demanded. 

Each Warburg's Pill represents about i fluidrachm (4 
Cc.) of Warburg's Tincture. (See Tinctura Antiperiodica^ 
CoLOCYNTHiDis CoMPOSiT/E (Pilulae Cochia). — Extract of Colo- 
cynth, grain \ (ooi); Aloes, Resin of Scammony, of each, 
grains 2 (0.13); Oil of Cloves, min. \ (0.015). 
CoLOCYNTHiDis ET Hyoscyami. — Extract of Colocynth, grain 
-^ (0.006) ; Aloes, Resin of Scammony, Ext. Hyoscyamus, 
each, grains i^ (o.i); Oil of Cloves, min. -J- (0.0 1 ). 
COLOCYNTHIDIS ET PoDOPHYLLi. — Compound Extract of Colo- 
cynth, grains i^ (0.16); Resin of Podophyllum, grain \ 
(0.015). 
Ferri Composite (U. S. P. 1880).— Myrrh, \\ grains (o.i); 
Ferrous Sulphate, Sodium Carbonate, each, f grains (0.048). 
Galbani Composit.e (U. S. P. 1880).— Galbanum, Myrrh, 

each, i\ grains (0.1); Asafcetida, \ grain (0.03). 
Glonoini (Nitroglycerin).— Spirit of Glonoin (i per cent.), 
Athaea, each, grains 200 (13.0); Confection of Rose, a suf- 
ficient quantity. Make a mass and divide it into two hun- 
dred (200) pills. Each pill contains -^ grain (0.000;) of 
Glonoin (Nitro-glycerin). 
Laxative Post-partum (Barker's).— Ext. Colocynth. Comp., 
grains i| (0.1) ; Aloes, grain f (0.05) ; Res. Podoph., Ipecac.^ 
each, -^ grain (0.005); Ext. Nux Vomica, -^ grain (0.03); 
Ext. Hyoscyamus, \\ grains (0.8). 

This is the formula generally employed by Dr. Fordyce 
Barker, except where special circumstances render modi- 



114 A TEXT-BOOK OF MATERIA MEDIC A. 

Pilulse— 

fications necessary. The formula usually quoted in manu- 
facturers' lists and some formularies is not correct. 

Metallorum (Metallorum Amarae). — Reduced Iron and 
Quinine Sulphate, each, grain i (0.06) ; Strychnine and Ar- 
senous Acid, of each, grain -^-^ (0.003). 

Aitken's Tonic Pill is a similar combination : 

Reduced Iron, grain \ (0.04) ; Quinine Sulphate, grain i 
(0.06); Strychnine, Arsenous Acid, each, grain -^ (0.0012). 

Opii et Camphors. — Powdered Opium, i grain (0.06) ; Cam- 
phor, grains 2 (0.13). 

Opii et Plumbi. — Powdered Opium and Acetate of Lead, 
each, grain i (0.06). 

PoDOPHYLLi, Belladonna, et Capsici (Squibb's Podophyllum 
Pills). — Resin Podophyllum, grain \ (0.015); Capsicum, 
grain \ (0.03) ; Ext. Bellad. Ale, grain \ (0.008) ; Sugar of 
Milk, grain i (0.06) ; Acacia, Glycerin, and Syrup, each, 
a sufficient quantity. 

QuADRUPLiCES (Ferri et Quininae Compositse). — Ferrous Sul- 
phate, Quinine Sulphate, Aloes, each, grain i (0.06); Ext. 
Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. 

Triplices (Triplex). — Aloes, grains 2 (0.13); Resin Podo- 
phyllum, grain \ (0.015); Mass of Mercury, grain i (0.06). 
When Pilula Triplex, under this name or some equiva- 
lent, is prescribed without further specification, the N. F. 
recommends that the above preparation be dispensed. A 
formula devised by John W. Francis is also in use : 

2. Fim7icis\s Triplex Pill. — Aloes, Scammony, Mass of 
Mercury, of each, grain f (0.05); Croton Oil, ^ min. (0.003); 
Oil of Caraway, grain \ (0.015); Tincture of Aloes and 
Myrrh, a sufficient quantity. 

UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL 

USE. 

Graitules are small pills, less than I grain (0.06) in weight, 
usually sugar-coated and containing alkaloids and other active 
drugs. 

Parvules are identical with granules. They are usually colored 
red or pink. 

Globules {OrbicidcE) are sugar pellets to be saturated with alco- 
holic solutions of medicinal agents, chiefly in Homoeopathy. 



PREPARATIONS FOR EXTERNAL USE. 1 15 

Compressed Pills are made by compressing powders into disks 
not exceeding 5 grains (0.3) in weight, without any excipient. 

Friable Pills are made by aggregation, spreading the powdered 
mixture upon nuclei or sugar granules in a revolving pan until the 
pills are formed. 

Bolus is the name given to pills exceeding 5-10 grains (0.3-O.6) 
in weight, used in veterinary practice. A sugar-coated bolus is 
called a Dragee. 

RottdcB are disk-shaped forms of sugar about i^ grains (o.i) in 
weight, which may be flavored with alcoholic solution (spirits). 

Bacilli are cylindrical sticks, a form of lozenge (Licorice). 

LamellcB, thin squares of gelatin in which the active agent has 
been incorporated, intended for solution in the eye. 



PREPARATIONS FOR EXTERNAL USE. 

To this group belong the liquid preparations : Liniments, 
Oleates and Collodions, and the mixtures of solids : Ointments, 
Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- 
times incorrectly called the " base," consists chiefly of fatty sub- 
stances which serve as protectives or facilitate absorption. The 
Collodions are, however, an exception. 

The solid mixtures may be classified according to their fusi- 
bility, or melting-points, because their therapeutic uses, as well as 
their pharmaceutical forms, are through this quality respectively 
determined. 

Ointments fuse at the body-temperature, and therefore produce 
an emoUient effect, or induce absorption of the medicinal substance 
by the system. They are applied by rubbing or inunction. 

Cerates have a higher fusing-point, due to Wax they contain ; 
the medicinal agent is not so readily absorbed, and they are there- 
fore used to produce local effects, being spread on cloth and applied 
as dressings. 

Suppositories have the same fusibility as cerates, and may be said 
to be cerates intended for application to the orifices of the body, both 
for absorption and local effect. 

Plasters have a still higher fusibility ; they do not melt, but 
become adhesive by the body-temperature, and are intended to 
produce local effects and afford mechanical support to the parts 
affected. 



Il6 A TEXT-BOOK OF MATERIA MEDICA. 

The fusibilities of these various preparations are likewise gov- 
erned by the respective vehicles employed. 

LINIMENTA— LINIMENTS. 

The Liniments are liquid preparations for external use, consist- 
ing of solutions of oily or resinous constituents in Alcohol or Oils, 
or mixtures of liquid Soaps. The nine official Liniments are 
prepared by simple admixture or solution. 
Linimentum — 

Ammoniae . . cotton seed oil 60 Cc. ; ammonia water 35 Cc. ; 

alcohol 5 Cc. 
Belladonnse . . . fl. ext. belladonna 95 Cc. ; camphor 5 Gm. 
Calcis (Carron Oil) . . linseed oil 50 Cc; lime solution 50 Cc. 
Camphorae .... cotton seed oil 80 Gm.; camphor 20 Gm. 
Chloroformi .... soap liniment 70 Cc. ; chloroform 30 Cc. 

Saponis camphor 4.5, soap 7, 

rosemary oil i ; alcohol 75 ; water, to lOO Cc. 

Saponis MoUis, alcohol 35 Cc. ; lavender oil 2; soft soap 65 Gm. 

Sinapis Comp. . . . fl. ext. mezereum 20; mustard oil, vol. 3, 

camphor 6; castor oil 15 ; alcohol, to lOO Cc. 

Terebinthinse . . resin cerate 65 Gm.; turpentine oil 35 Gm. 

Unofficial Liniments of the National Formulary. 
Linimentum — 

AcoNiTi ET Chloroformi. — Tincture of Aconite, Chloroform, 

each, 2 fluidounces (60 Cc.) ; Soap Liniment, 12 fluidounces 

(355 Cc). 
Ammonii Iodidi. — Iodine, 30 grains (2.) ; Oil of Rosemary, 

Oil of Lavender, each, no minims (7 Cc) ; Camphor, 220 

grains (15.); Water of Ammonia, if fluidounces (50 Cc) ; 

Alcohol, enough to make 16 fluidounces (473.17 Cc). On 

standing, it becomes colorless. 
Cantharidis (U. S. p. 1880). — Oil of Turpentine containing 

15 per cent, of Cantharides. 

lODi (similar to Ph. Br.). — Iodine, 900 grains (60.) ; Potassium 
Iodide, 360 grains (24.); Glycerin, J fluidounce (15 Cc) ; 
Water, i fluidounce (30 Cc) ; Alcohol, enough to make 

16 fluidounces (473.17 Cc). 

Opii Compositum (Canada Liniment). — Tincture of Opium, i-J- 
fluidounces (45 Cc.) ; Camphor, 120 grains (8.); Alcohol, 4 
fluidounces (118 Cc.) ; Oil of Peppermint, 180 minims 



PREPARATIONS FOR EXTERNAL USE. 117 

Linimentum — 

(12 Cc); Water of Ammonia, 6 fluidounces (180 Cc.) ; 
Oil of Turpentine, enough to make 16 fluidounces 

■ (473-17 Cc). 

Plumbi Subacetatis (U. S. p. 1880). — Solution of Lead Sub- 
acetate, 35 parts; Cotton Seed Oil, 65 parts. 

Saponato-camphoratum (Opodeldoc ; Solid Opodeldoc). — 
White Castile Soap, ij ounces (45.); Camphor, J ounce 
(15.); Alcohol, 20 fluidounces (592 Cc.) ; Oil of Thyme, 30 
minims (2 Cc.) ; Oil of Rosemary, 60 minims (4 Cc.) ; Water 
of Ammonia, Fort., i fluidounce (30 Cc). 

Terebinthin^ Aceticum (Linimentum Album., Stokes' Lini- 
ment ; St. John Long's Liniment). — Oil of Turpentine, 3 
fluidounces (89 Cc.) ; Fresh Egg, i ; Oil of Lemon, 60 
minims (4 Cc.) ; Acetic Acid, 300 minims (20 Cc) ; Rose 
Water, 2^ fluidounces (75 Cc). 

TiGLii (Linimentum Crotonis, Ph. Br.). — Croton Oil, 2 fluid- 
drachms (8 Cc); Oil of Cajuput, 7 fluidrachms (27.5 
Cc). 

TiGLii CoMPOSiTUM. — Crotou Oil, I fluidounce (30 Cc.) ; Oil 
of Sassafras, i fluidounce (30 Cc.) ; Oil of Turpentine, i 
fluidounce (30 Cc.) ; Oil of Olive, 2 fluidounces (60 Cc). 

LOTIONES— WASHES. 
Lotio — 

Adstringens (Warren's Styptic).— A mixture of Sulphuric 

Acid, Oil of Turpentine, and Alcohol. 
Flava (Yellow Wash, Aqua Phagedsenica Flava, Ph. Ger.). 
— Corrosive Mercuric Chloride, 24 grains (1.5), in Lime 
Water, 16 fluidounces (473 Cc). 
Nigra (Black Wash; Aqua Phagedsenica Nigra, Ph. Ger.). 
— Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 
16 fluidounces (473 Cc). 
Plumbi et Opii (Lead-and-Opium Wash).— Lead Acetate, 
120 grains (8.); Tincture of Opium, J fluidounce (15 Cc.) ; 
in Water, 16 fluidounces (473 Cc). To be shaken when 
dispensed. 
The following are unofficial solutions and mixtures for external 
use: 

hijectio, -ones. — Aqueous solutions for introduction by means 
of a syringe in the orifices of the body. 



Il8 A TEXT-BOOK OF MATERIA MEDICA. 

Injectio Hypodermica. — Solution for hypodermic or subcu- 
taneous injection. 

Enema, -atis ; Clyster. — A warm solution of Soap or a muci- 
laginous mixture for injection in the rectum to produce 
evacuation, or for nutrition. 

Gargarisma, -atis ; Gargle. — A wash or lotion for the throat. 

Collyriuin, -i ; ''Eye-wash!' — A weak solution for instillation 
in the eyes. 

Nebula, -cb ; Spray. — A liquid intended for application by 
means of an atomizer. 

Vapor, -oris ; Inhalatio?i. — Volatile agents to be added to 
boiling water and inhaled, to affect the air-passages. 

Balneum, -ei ; Bath. — Mixture to be added to water for bath- 
ing purposes. 

OLEATA— OLEATES. 

The official Oleates are solutions of oleates in Oleic Acid. 
They are distinct from the sohd oleates, which are made by double 
decomposition of salts of the metals and alkaline earths and 
sodium oleate, or Soap. (See Soap) 

The liquid Oleates are intended for endermic medication. They 
are applied by inunction, when the Oleic Acid favors the absorp- 
tion of the medicinal agent, the oleate in solution. When it is not 
desirable to administer remedies by the mouth, the Oleates afford 
an effective form of medication. 

The solid Oleates are either dry powders, well adapted for pro- 
tectives as dusting powders, or soft, pliable masses to be appHed in 
the form of ointments or plasters. 

Three are official — two liquid, and one, Zinc Oleate, semi-solid. 
They are made by incorporating the solid with the Oleic Acid, 
contained in a warm mortar, and effecting solution with a gentle 
heat : „ 

Percentage 
• by weight. 

Oleatum Hydrargyri .... yellow mercuric oxide 20. 

Oleatum Veratrinae veratrine 2. 

Oleatum Zinci Oxidi zinc oxide 5. 

Unofficial Oleates of the National Formulary. 

The following are simply solutions of the alkaloids in Oleic 
Acid: 



PREPARATIONS FOR EXTERNAL USE. 119 

Oleatum — 

AcoNiTiN^. — Contains 2 per cent, of crystallized Aconitine 

(Duquesnel's). 
Quinine. — Contains 25 per cent, of Quinine (Alkaloid). 

Of the solid Oleates introduced by Dr. J. V. Shoemaker, the 
following have been recognized, but others may also be prepared 
as desired : 

Oleatum Plumbi. — Contains about 28 per cent, of Lead Oxide. 

It is of the consistence and general character of Lead Plaster, 

and suggests similar use. 
Oleatum Zinci. — In the form of a soft white powder, useful as 

a "dusting powder," or converted into a plaster or ointment 

by mixing it with such proportion of Oleic Acid as may be 

required. 

OLEA INFUSA— INFUSED OILS. 

These preparations are obtained by infusing a dry herb, usually 
from the so-called narcotic plants, in five times its weight of a 
mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum 
Hyoscyami Infiisimi is the most familiar example. 

Oleum — 

Carbolatum. — A mixture of Cotton Seed Oil with 5 per cent, 
of Carbolic Acid. 

Hyoscyami Compositum (Balsamum Tranquillans). — Infused 
Oil of Hyoscyamus, with a small proportion of each of the 
Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. 

COLLODIA— COLLODIONS. 

The Collodions are solutions in Ether-Alcohol of Pyroxylin or 
Soluble Gun Cotton. Upon evaporation of the solvent the remain- 
ing film excludes the air, thus protecting abraded surfaces. Col- 
lodion is also used as a vehicle when a prolonged local effect is 
desired. 

The following forms are official : 

Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 3 

Collodium Flexile . . . castor oil 3 ; Canada turpentine 5 

Collodium Acidi Tannici . . alco. 5 ; ether 25 ; acid tan. 20 
Collodium Cantharidatum (Blistering Collodion) . (flex. 

collo.) cantharides 60 



I20 A TEXT- BOOK OF MATERIA MEDIC A. 

Unofficial Collodiojis. 
Collodium — 

loDATUM (Iodized Collodion). — Contains 5 per cent. Iodine in 

Flexible Collodion. 
loDOFORMATUM (Iodoform Collodion). — Contains 5 per cent. 

Iodoform in Flexible Collodion. 
Salicylatum Compositum (Corn Collodion). — Contains 1 1 per 

cent. Salicylic Acid and 2 per cent. Ext. Cannabis Indica in 

Flexible Collodion. 
TiGLii (Croton Oil Collodion). — Contains 10 per cent. Croton 

Oil in Flexible Collodion. 

UNGUENTA— OINTMENTS. 

Ointments are mixtures of a fatty vehicle with which medicinal 
agents are incorporated, readily fusing at the body-temperature, 
35° to 40° C. (95° to 104° F.). 

The vehicles used are : Benzoated Lard, Ointment (simple). Lard, 
and Wax or Spermaceti in different proportions. Lard Oil, Olive 
Oil, and Suet. Petrolatum and Wool-fat [Adeps Lance Hydrosus, 
U. S. P.) are employed in unofficial ointments. 

The medicinal ingredients must be minutely distributed through 
the vehicle in order that the ointment may not prove irritating, and 
that the greatest possible surface be presented to the epidermis 
with a view to quick and uniform absorption. For this reason the 
highest quality of an ointment (next to its proper melting-point) is 
smoothness. In the preparation of ointments care must therefore 
be taken that the method employed be such as to yield smooth 
products. 

The melting-point is governed by the fusibility of the vehicle 
used, which is either officially directed, as in official preparations, 
or in extemporaneous preparations prescribed by the physician. 

The twenty-three official Ointments are prepared (i) by me- 
chanical admixture, (2) by fusion, or (3) by chemical reaction. 

Mixing the medicinal substances with the fatty body in a mor- 
tar or on a slab is the process usually employed for soHd sub- 
stances, especially when insoluble in the fat. Powdered drugs, 
acids, alkaloids, extracts, and salts (not attended by chemical 
union) are examples adapted to this process. 

The following points must be observed : 

Solids must be in a fine powder before being incorporated with 
the vehicle : sometimes it is an advantage to triturate the solid with 



PREPARATIONS FOR EXTERNAL USE. 121 

a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, 
into a smooth cream before it is mixed with the vehicle proper — 
Lard, etc. 

Extracts should be reduced to a semi-liquid condition by tritura- 
tion with a little dilute Alcohol or Water. Substances soluble in 
fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- 
solved directly in the fat by the aid of a gentle heat. 

The followincr are the official Ointments, with their drug-- 
strengths, their respective vehicles being given in parentheses : 

Percentage 
Unguentum — of Drugs. 

Acidi CarboHci (ointment) 5 

Acidi Tannici (benz. lard) 20 

Aquae Rosae (Cold Cream) . . spermaceti 12.5 ; white 

wax, 1 2 ; expressed oil of almond 60 

then incorporate borax 0.5 ; rose water 19 

Belladonnae (dil. alcohol 5) extract . . . (benz. lard) 10 

Chrysarobini (chrysophanic acid) " 5 

Diachylon (Hebra's) lead plaster 50 

oil lavender i ; olive oil 49 

Gallae (benz. lard) 20 

Hydrargyri (Blue Ointment) mercury 50 

mercuric oleate 2 ; suet 23 ; lard 25 

Hydrargyri Ammoniati (benz. lard) 10 

Hydrargyri Oxidi Flavi (ointment) 10 

Hydrargyri Oxidi Rubri (castor oil 5) . . . " 10 

lodi (potass, iod. i, water 2 parts) .... (benz. lard) 4 

lodoformi " 10 

Picis Liquidae . . . yellow wax 12.5 ; lard 37.5 ; tar 50 

Plumbi Carbonatis (benz. lard) 10 

Plumbi lodidi " 10 

Potassii lodidi (sod. hypo, sulph. i ; water 10) " 12 

Stramonii (dil. ale. 5) Extract " 10 

Sulphuris (washed) " 30 

Veratrinae (olive oil 6) " 4 

Zinci Oxidi " 20 



Unofficial Ointments of the National Formulary. 

Unguentum Acidi Gallici (U. S. P. 1880). — Contains 10 per 
cent. Gallic Acid. 



122 A TEXT-BOOK OF MATERIA MEDICA. 

Unguentum Calamine (Unguentum Zinci Carbonatis Im- 
puri; Turner's Cerate). — Contains 17 per cent. Zinc Car- 
bonate (Imp.). 

Unguentum Camphors (Unguentum Camphoratum). — Con- 
tains 20 per cent. Camphor. 

Unguentum Fuscum (Unguentum Matris ; Mother's Salve). 
— Contains 50 per cent, of Camphorated Brown Plaster 
(N. F.). 

Unguentum Mezerii (U. S. P. 1880). — Represents 25 per 
cent. Mezereum. 

Unguentum Picis Compositum (Tar, Comp.). — Contains Oil 
of Tar, 4 per cent. ; Tincture of Benzoin, 2 per cent. ; and 
Oxide of Zinc, 3 per cent. 

Unguentum Sulphuris Alkalinum (U.S. P. 1880).— Contains 
20 per cent. Sulphur and 10 per cent. Potassium Carbonate. 

Unguentum Sulphuris Compositum (Wilkinson's Ointment; 
Hebra's Itch Ointment). — Precipitated Calcium Carbonate, 
10; Sublimed Sulphur, Oil of Cade, of each, 15; Soft 
Soap and Lard, of each, 30 parts. The Lard is mixed 
with the Soft Soap and Oil of Cade ; the Sublimated 
Sulphur and Precipitated Calcium Carbonate are then grad- 
ually incorporated. 

CERATA— CERATES. 

Cerates are mixtures of fats similar to the ointments, but of 
firmer consistence, because they contain Wax or Resin (having a 
higher melting-point than Lard) in greater proportion than do oint- 
ments. In the preparation of Cerates the same rules are to be 
observed as noted under Ointments. 

The six official Cerates are prepared by fusion or simple admix- 
ture, and one by extraction and digestion (Ceratumx Cantharidis) : 

Percentage 
of Drugs. 

Ceratum (Simple) lard 70 ; white wax 30 

Camphorae . camphor liniment 10; lard 60 \ white wax 30 

Cantharidis (Blistering Cerate) . . .oil of turpentine 15 

lard, 22 ; cantharides 32 

yellow wax, resin, each 18 

previously fused, and evaporate to 100 

Cetacei . . . olive oil 55 ; white wax 35 ; spermaceti 10 



PREPARATIONS FOR EXTERNAL USE. 123 

Percentage 
of Drugs. 

Plumbi Subacetatis (Goulard's Cerate), camphor cerate 80 

solution lead subacetate 20 

Resinae (Basilicon) . . yellow wax 15 lard 50; resin 35 
in cold weather yellow wax 12; 

lard 53; resin 35 

In the " Blistering Cerate " the maceration in Turpentine Oil 
and subsequent digestion dissolve the vesicating principle of the 
Cantharides, and the preparation is therefore more active. 

Ceratum Camphors Compositum, N. F. (Camphor Ice). — 
Moulded into small cakes suitable for popular use as an applica- 
tion to excoriated surfaces. It contains very small quantities of 
Benzoic and Carbohc Acids. 

Ceratum Extracti Cantharidis (U. S. P. 1880). — Repre- 
sents 30 per cent. Cantharides. 
Ceratum SABiNiE (U. S. P. 1880). — Represents 25 per cent 
Sabine. 

SUPPOSITORIA— SUPPOSITORIES. 

Suppositories may be defined as variously shaped masses of 
medicated fat, possessing a consistence ensuring their quick fusion 
when introduced in the orifices of the body. 

The U. S. P. defines Suppositories with reference to their 
weights and shapes, corresponding to their several uses — i. e. for 
introduction in the respective orifices of the body — as follows : 

Rectal, cone-shaped, should weigh 15 grains (i Gm.). 

Urethral, pencil-shaped, should weigh 15 grains (i Gm.). 

Vaginal, globular, should weigh about 45 grains (3 Gm.). 

The vehicle is Cacao Butter {Oleum Theobromatis^, which pos- 
sesses the property of melting at the temperature of the human 
body, 35° G (95° F.), and yet remaining firm at ordinary tempera- 
tures. An addition of 10 per cent, of spermaceti has been recom- 
mended to raise the melting-point and thus give more stability to 
suppositories during the heated seasons of the year. 

The U. S. P. gives a general formula for preparing supposi- 
tories ; only one Suppository is official, and this is not made from 
Cacao Butter. 

The methods of preparing suppositories are quite numerous : 
any process may be employed by which the product is obtained 
uniform in size and shape and with the medicinal ingredients thor- 



124 A TEXT-BOOK OF MATERIA MEDIC A. 

oughly incorporated. Moulds are usually employed ; the medici- 
nal ingredients, if solid, are first reduced to powder in a mortar, 
and mixed with a small quantity of the grated Fat ; the remainder 
of the Fat, previously melted and cooled to 35° C, is then gradually 
incorporated with this mixture, thoroughly mixed, and, if possible, 
without further heating, poured into the moulds, previously chilled. 

Another process consists in rolling the mass on a slab, cutting 
it as in making pills, and forming the cones with the fingers. By 
cold compression in a screw-press *' machine," suppositories may 
be formed from the prepared mass. 

Urethral Suppositories are commonly called Bougies, or, more 
properly, Medicated Bougies. They are usually made with the 
addition of Wax, or from Glyco-gelatin mass. 

Suppositoria Glycerini. — Made by reaction of Sodium Carbonate 
5 grains (0.3), in Glycerin \\ grains (6 Gm.), with Stearic Acid 
8 grains (0.5), and heating until a solution of sodimn stearate or 
soap is formed, which is poured into a mould. Upon cooling, the 
mixture gelatinizes and the suppository is wrapped in tin-foil. 

Uses. — Upon introduction into the rectum the mass melts, and 
the Glycerin, acting upon the feces, produces evacuation. 

Rectal suppositories are usually made twice the official size, or 
30 grains (2 Gm.). 

A formula for suppositories would be : 

Extracti Belladonnae FoL, ale, o.i ; 
Acidi Tannici, i.o; 

Olei Theobromatis, q. s. (20 Gm.). 
Fiant suppositorise No. x. (2 Gm.). 

Each suppository would contain \ grain (0.0 1) Ext. Belladonna 
and \\ grains (o.i) Tannic Acid. 

EMPLASTRA— PLASTERS. 

Plasters are mixtures of various fatty or resinous solids of such 
high melting-point as to be friable when cold, but rendered adhesive 
by the warmth of the body. 

The vehicles of plasters are : Lead plaster ; resinous substances, 
made adhesive by admixture with the medicinal ingredients ; and 
simple plasters, such as isinglass. 

The making of plasters does not differ materially from the pro- 
cess employed for ointments and cerates, since they are all prepared 
by melting the various substances and incorporating the medicinal 



PREPARATIONS FOR EXTERNAL USE. 125 

substances last. The spreading of plasters, though usually done 
on a large scale, may be easily effected by the pharmacist with 
the use of a plaster iron. 

The thirteen official Plasters may be divided into — (i) Lead 
Plasters ; (2) Pitch and Gum-Resin Plasters, and (3) Isinglass 
Plaster. 

(i) The most important plasters are made from Lead Plaster, 
or Lead Plaster mixed with Resin, the official Resin Plaster. 

Percentage or 
Emplastrum— /^^^-^ ^'^ "'''' 

Plumbi (Diachylon) .... olive oil 60; lead oxide 32 

mix, and add to water 10 
Boil the mixture until the reaction has ceased and 
the plaster is of the right consistence, replacing 
water lost by evaporation from time to time. 

Resinse (Adhesive) yellow wax 6 ; resin 14 

lead plaster 80 
Saponis lead plaster 90 ; soap 10 

From these the following are prepared : 
Emplastrum — 

Arnicae resin plaster 67 ; extract arnica root 33 

Belladonnae ext. belladonna leaves 20 

resin plaster, soap plaster, each 40 
Capsici . . . resin plaster, oleoresin capsicum q. s. 
Hydrargyri, lead plaster 70; mercury oleate 1.2; mercury 30 

Containing lead plaster and pitch : 
Emplastrum — 

Ferri (Strengthening) . . . olive oil, 5 ; ferric hydrate 9 

Burgundy pitch 14; lead plaster 72 

Opii . Burgundy pitch 18 ; lead plaster "j^^ ext. opium 6 

Picis Cantharidatum (Warming) . . . Burgundy pitch 92 

cerate cantharides 8 
(2) Pitch and Gum Resin Plasters : 

Emplastrum — 

Ammoniaci cum Hydrargyro .... oleate mercury 0.8 

mercury 18 

ammoniac 72; dil. acetic acid, lead plaster, to lOO 

Picis Burgundicae olive oil 5 ; yellow wax 1 5 

Burgundy pitch 80 



126 A TEXT-BOOK OF MA TERIA MEDICA. 

(3) Isinglass plaster (Emplastrum Ichthyocollse ; Court-plaster). 
— A solution of 10 Gm. Isinglass is dissolved in hot Water 120 
Gm. ; one-half of the solution is spread upon silk (taffeta) in suc- 
cessive layers, and when dry the other half of the solution is spread 
on in a similar manner, after first having been mixed with Alcohol 
40 Gm., Glycerin i Gm. The taffeta is then coated on the reversed 
side with Tincture of Benzoin to make it waterproof and antiseptic. 

U^iofficial Plasters of the National Formulary. 
Emplastrum — 

Ammoniaci (U. S. p. 1880). — Gum-resin Ammoniac with 
Acetic Acid. 

Aromaticum (Spice Plaster), — Consisting of Cloves, Cinna- 
mon, and Ginger, each, 10 per cent; Capsicum and Cam- 
phor, each, 5 per cent. 

AsAFCETiD^ (U. S. P. 1880). — Asafoetida 35 p.; Galbanum 15 
p. ; with Lead Plaster. 

FuscuM Camphoratum (Matris Camphoratum, Ph. Ger.). — 
Camphorated Mother's Plaster. A plaster similar to lead 
plaster, and containing camphor, i per cent. 

Galbani (U. S. p. 1880). — Galbanum Plaster. 

Picis Canadensis (U. S. P. 1880). — Canada Pitch Plaster. 

Picis Liquids Comp. — A mixture of Resin and Tar, with Podo- 
phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. 

CHARTS— PAPERS. 

There are two Papers official. One is made by saturating strips 
of white unsized paper in a 20 per cent, solution of Potassium 
Nitrate and drying; the other is paper coated with Mustard, used 
similarly to the Plasters : 

Charta Potassii Nitratis .... potass, nitrate 20 ; water 80. 

Vapors from incineration as inhalant. 
Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. 
The Mustard is freed from the fixed oil by extraction with Ben- 
zin, and mixed with a solution of India Rubber in equal volumes 
of Benzin and Carbon Bisulphide, and spread upon Paper. This 
is the well-known Mustard Plaster or Mustard Paper. When 
applied, the paper should be immersed in lukewarm water for a 
few minutes, in order to render the vesicating principle active. 
Charta Cantharidis, U. S. P. 1880. — Cantharidis Paper (Blis- 
tering Paper). 



PREPARATIONS FOR EXTERNAL USE. 127 

Poultice or Cataplasm (Lat. Cataplasma, -atis). — A coarsely 
ground substance or mixture of substances, such as flaxseed or 
elm-bark, made into a mass with hot water or some other liquid, 
spread upon cloth or filled into porous bags, and applied to the 
body while hot. 

Fomentations (Lat. Foinentuni, -i). — Porous woollen cloths sat- 
urated with hot infusion or decoction of herbs, or other hot liquids 
or lotions, and applied hot. 

Spongiopiline. — A thick cloth covered with layers of sponge 
for the saturation and retention of medicinal agents intended for 
absorption, the exterior being composed of waterproof material, 
such as rubber. 

Plaster-Mull. — A thin cloth made impervious with rubber or 
gutta-percha tissue, upon which is spread or painted medicinal 
agents in the liquid form, intended for local application. 

Caustics or Escharotics (Gr. Escharotikos). — Substances used 
to destroy tissue by chemical action or by heat, either semi- 
solid mixtures made into a paste with starch or other diluent, or 
chemicals fused and moulded into sticks called pencils or " crayons " 
(Lat. stilus, -z), to be applied directly to the skin. Moxa is the 
name given to small cones of combustible substances which upon 
incineration do not inflame, but give off an intense heat, used for 
cauterization when heat is desired. 

Bandages; Antiseptic Dressings. — The material used for 
bandages is cellulose in various modifications, such as cotton, 
linen, jute, and other fi.brous substances. Aside from the me- 
chanical support afforded, bandages also serve to keep wounds 
clean by absorbing and withdrawing secretions (pus) which would 
otherwise prove irritating, and by protecting them against extrane- 
ous matter serve to promote the healing process. 

These various substances may be used either plain or medi- 
cated, when they are called antiseptic. 

Gossypiuni Purificatum, U. S. P. ; Absorbent Cotton. — The hairs 
of Gossypium herbacenm L., freed from oil and resinous substances 
by treatment with alkalies and bleaching agents. These hairs rep- 
resent microscopic ducts in which liquids are absorbed through 
capillarity. The freer from oily constituents, the more readily will 
watery liquids be taken up and retained ; hence the absorbability of 
cotton depends upon its purity. This is equally true with all other 
bandage material. 

Linen in the form of thin sheets, known as Muslin or Muslin- 



128 A TEXT- BOOK OF MATERIA MEDIC A. 

gauze, or purified similarly to cotton, when it is called Lint, is 
made from the bast-fibres of the Limun usitatissimum L., Flax.. 
Hemp and Jute are the bast-fibres of their respective plants. 

Medicated Dressings. — These are made by saturating the ma- 
terial or vehicle in a solution of certain strength of the medicinal 
agent, or incorporating the latter in powdered form. In the appli- 
cation of a dressing which has been rendered aseptic or antiseptic 
by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, 
Mercuric Chloride, or similar agent, it is desired to bring in con- 
tact with the wound a solution of certain strength — for example,, 
a 5 or 10 per cent, solution of Phenol, 2. ^ ox ^ oi i per cent, 
solution of Mercuric Chloride, etc. The quantity of material which 
conveys the agent is of no consequence, as the fabric simply serves 
as a vehicle for the medicinal or antiseptic agent. The strengths 
of such dressings should therefore be designated by the percentage- 
strength of the solutions by which they are saturated, rather than by 
the percentage by weight of the medicinal agent the finished dress- 
ing may contain. 

In dressings of antiseptic agents that are usually applied in sub- 
stance, such as Boric Acid and Iodoform, the percentage-amount 
actually contained by weight in the finished dressing should be 
stated. Here the use of a vehicle is only a matter of convenience, 
and it is desirable to know just how much of the medicinal agent 
is contained in a certain quantity by weight or by area of the 
dressing. 

Medicated Cottons. — Purified cotton is saturated in a solution 
in Water, or Glycerin and Water, of the strength desired of the 
medicinal agent, and thoroughly expressed. 

The following are the usual strengths : 

Percentage.. 

Gossypium Boratum acid boric 5 or 10 

Carbolatum phenol 5 or 10 

lodoformatum iodoform 10 to 20 

Salicy latum acid salicyHc 10 to 20 

Stypticum Monsel's solution 

Sublimatum mercuric chloride y^ to ^-^ 

Iodoform, being insoluble in Water, should be dissolved in Ether 
or, preferably, in a mixture of Alcohol and Glycerin. 

Medicated Gauzes ; Carbasa. — The material used for making 
Medicated Gauzes is a muslin gauze free from sizing or other ex- 
traneous matter. The gauze is thoroughly impregnated with the 



PREPARATIONS FOR EXTERNAL USE. 129 

solution of the particular strength required, then forcibly expressed, 
after which it is ready for use ; or, if desired for future use, it should 
be tightly rolled, wrapped in parchment paper, and kept in closely 
covered boxes in a cool, dry place. 

The following are the most commonly used Gauzes and their 
strengths : 

Percentage. 

Carbasus Boratum . ■ acid boric 5-10 

Carbolatum phenol 5-10 

lodoformatum iodoform 10-20 

Salicylatum acid salicyHc 10-20 

SubHmatum mercuric chloride 2^0 A 

The Iodoform Gauze is made in the same way as the Cotton, 
by saturation with a solution of Iodoform in Alcohol and Glycerin. 
All the others, except the Mercurial Gauze, contain Glycerin. 
Mercuric Chloride is dissolved in Water with a little Acid Tartaric 
(5 parts for i of Mercuric Chloride), the presence of which in the 
Gauze prevents the formation of insoluble albuminate of mercury 
when it is brought in contact with the albuminous discharges from 
wounds. 

Plaster-of-Paris bandages are made by thoroughly incorpo- 
rating Calcium Sulphate (gypsum) into linen bandages. When 
applied, the bandage, after being dipped in water, sets hard and 
firm in a few minutes. 



CLASS I.-DISEASE MEDICINES 



DIVISION I.— RESTORATIVES. 



GROUP I.— DIGESTANTS. 

[In the present work care has been taken to designate the proper pronunciation 
[Foster) of the names of drugs and their preparations common to Materia Medica and 
Therapeutics. The simplest and most efficient method appears to be that herein fol- 
lowed — namely, to indicate accent and quantity by a single sign ; for example, Pep- 
sinum (nom.) — Pepsini (gen.), in which the i is long and the accent upon the second 
syllable; Cocculus — Cocculi, in which the o is short and the accent upon the first 
syllable. 

In nearly all cases the genitive, as used in prescription-writing, and the English 
equivalent, are given. When the accusative, not genitive, is adopted, the usage is 
marked by "(ace.)"; as Pilulse, Pilulas (ace), etc.] 

PepsTnum— Pepsini— Pepsin. U, S, P, 

Origin. — A proteolytic ferment or enzyme obtained from the 
glandular layer of fresh stomachs from healthy pigs, and capable 
of digesting not less than 3000 times its own weight of freshly 
coagulated and disintegrated Qgg albumen when tested by the 
process given in the United States Pharmacopoeia. 

Description and Properties. — A fine white, or yellowish-white, 
amorphous powder, or thin, pale yellow, or yellowish, transparent 
or translucent grains or scales, free from offensive odor, and having 
a mildly acidulous or sHghtly saline taste, usually followed by a 
suggestion of bitterness. It slowly attracts moisture when exposed 
to the air. Soluble, or for the most part soluble, in about 100 parts 
of water, with more or less opalescence ; more soluble in water acid- 
ulated with hydrochloric acid ; insoluble in alcohol, ether, or chlo- 
roform. Pepsin usually has a slightly acid reaction. It may be 
neutral, but should never be alkahne. 

Dose. — 5-60 gr. (0.3-4.0 Gm.). 

131 



132 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 
Pepsinum Saccharatum — Pepsini Saccharati — Saccharated Pepsin. 

Formula: Pepsin lo, Sugar of Milk 90 parts. Dose, 30 gr.-4 dr. (2.0-16.0 Gm.). 

Antag-onists and Incompatibles. — Tannic and gallic acids are 
incompatibles. Mineral salts, alcohol, and alkalies precipitate pep- 
sin from solution, the two latter impairing its digestive property. 
The ** Wine of Pepsin " is therefore unreliable. 

Synergists. — Diluted hydrochloric acid, in not over ^ of I 
per cent., increases its digestive action. 

Physiolog'ical Action. — Its only influence seems to be upon the 
digestive system. Pepsin is a typical restorative, being a normal 
constituent of the gastric juice, and in the presence of hydrochloric 
acid digesting the nitrogenous elements of the food, converting 
them into albumoses, and finally into peptones. 

Therapeutics. — Externally and Locally. — Its digestive action is 
utilized to dissolve or digest the false membrane in diphtheria and 
croup. A solution of pepsin has also been injected into the blad- 
der to digest blood-clots. It has been further recommended as 
an application to cancer of the cervix uteri. 

Internally. — As a restorative, where there is a lessened secre- 
tion of gastric juice, atonic dyspepsia, apepsia of infants, cancer of 
the stomacJi, and gastric ulcer, pepsin has proved serviceable. It is 
also employed to favor digestion in convalescence from acute and 
long illness. It is frequently necessary to give pepsin, or " pepton- 
ized milk," in acute dyspeptic diarrhea of infants. 

Administration. — Pepsin should be given in powder or dis- 
solved in glycerin (Glycerol of Pepsin), or in water acidulated with 
hydrochloric acid, directly after meals. 

The drug should not be given continuously for too long a 
period, lest the function of the stomach become impaired from 
disuse, the artificial digestion having replaced the natural, normal 
process. 

Unless there be some direct indication for its use, rather than 
give pepsin it is better to stimulate the gastric glands to secrete a 
larger amount of their normal juice, that they may not lie idle, 
and their function be consequently impaired by disuse. Hydro- 
chloric acid administered with pepsin probably slightly promotes 
glandular activity. Often, however, pepsin must be given, and in 
certain cases the stomach is in such a condition that nutrient en- 
emata must be administered. Yet, since the rectum possesses very 



DIGESTANTS. 133 

feeble powers of digestion, food should always be predigested. Sup- 
positories of peptonized meat are frequently used for this purpose. 

Pancreatlnum— Pancreatlni— Pancreatin. V. S. I*. 

Origin. — A mixture of the enzymes naturally existing in the 
pancreas of warm-blooded animals, usually obtained from the fresh 
pancreas of the hog. 

Description and Properties. — A yellowish, yellowish-white, or 
grayish amorphous powder, odorless, or having a faint, peculiar, 
not unpleasant odor, and a somewhat meat-like taste. Slowly and 
almost completely soluble in water, insoluble in alcohol. 

Pancreatin digests albuminoids and all proteid substances, and 
converts starch into sugar. Prolonged contact with mineral acids 
renders it inert. 

Dose. — 10-20 gr. (0.6-1.2 Gm.). 

Antagonists and Incompatibles. — Strong mineral acids. 

Synergists. — Weak alkalies. 

Physiological Action. — The four ferments which it contains 
render it capable, in either weak alkaline or acid media, of digest- 
ing nitrogenous substances ; emulsifying fats and oils, and re- 
solving them into fatty acids and glycerin ; converting starch into 
sugar ; and curdling milk. 

Therapeutics. — Like pepsin, it is used as an artificial agent in 
certain disorders of digestion. 

Administration. — It may be given dry, in powder, capsules, or 
compressed pills, or in solution. It should be administered in 
combination with an alkali, as the activity of pancreatin is de- 
stroyed by acids, and should be given ordinarily from two to four 
hours after meals, when the chyme has entered the intestine. It 
may also be administered immediately after eating or with the food, 
since there is an interval of from fifteen minutes to half an hour 
after the ingestion of food before the stomach-contents are ren- 
dered sufficiently acid by the gastric juice to interfere with the 
activity of the pancreatin. 

For rectal nourishment pancreatin is preferable to pepsin, be- 
cause of its superior action in predigesting food. 

Papain, Papoid, or Papayotin. 

Origin. — The inspissated juice of the unripe fruit of Carica 
Papaya. 

Description and Properties. — A whitish, slightly astringent 
powder, soluble in water. 



134 ^ TEXT-BOOK OF MA TERIA MEDICA. 

Dose. — 1-8 gr. (0.06-0.5 Gm.). 

Antagonists and Incompatibles. — Tannic and gallic acids. 
Lead salts and alcohol are incompatible with papain. 

Synergists. — The digestive ferments. 

Physiological Action. — In this it resembles pepsin, though dif- 
fering from the latter, as well as from pancreatin, in that it is 
equally active in neutral, alkaline, or acid media. It converts pro- 
teids into soluble peptones, and acts as a stimulant to the gastric 
glands. It converts starch into maltose, and upon false membranes 
acts more energetically than pepsin. It dissolves intestinal worms. 

Therapeutics. — Externally. — The uses of papain are more mani- 
fold than those of the digestive ferments previously mentioned. 
Like pepsin, it has been successfully employed to dissolve false 
membrane in diphtheria and croup. The juice of pineapple, which 
possesses a ferment (bromelin) similar to that of papain, is a val- 
uable domestic remedy in these diseases. Papain has been used 
with some benefit in indurated eczema and in syphilitic ulcerations 
of the tongue. It has been highly recommended by Johnston as a 
solvent oi cerumen: 15 drops (i.o Cc.) of a solution of 20 grains 
to I oz. (1.2 Gm-30 Cc.) of distilled water are dropped into the 
outer meatus, and the parts syringed an hour afterward with a 
solution of boric acid. 

Internally, papain may be used for the same purposes as pepsin 
and pancreatin ; yet, while theoretically superior, it is practically 
inferior to them, fortunately not having supplanted them in actual 
practice. 

Administration. — When used to aid digestion, papain should be 
given after meals, either in powders, capsules, compressed tablets, 
or aqueous solution freshly prepared. 



GROUP II.— FATS AND OILS. 

Oleum Morrhuae— Olei Morrhuae— Cod Liver Oil. 

TI. S. P. 

Origin. — A fixed oil obtained from the fresh livers of Gadus 
Morrhua L. and other species of Gadus. 

Description and Properties. — A pale-yellow, thin, oily liquid, 
having a peculiar, sHghtly fishy, but not rancid odor, and a bland, 
slightly fishy taste. Specific gravity 0.920 to 0.925 at 15° C. 
(59° F.). Scarcely soluble in alcohol, but readily soluble in ether, 



FATS AND OILS. 135 

chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. 
It contains several glycerides, the principal one being olein, traces 
of iodine, bromine, chlorine, biliary salts, phosphoric and sulphuric 
acids, a peculiar principle (gaduin), and several alkaloids. 

MoRRHUOL, a name given by Chapoteaut to a mixture of the 
various alkaloids and important principles of cod liver oil, occurs 
as an amber-brown, bitter, aromatic liquid. 

Dose. — 1-4 fluidrachms (3.8-15 Cc). 

Physiological Action. — Externally and Locally. — It possesses 
emollient properties, and may be applied to the skin and mucous 
membranes without causing irritation. It slightly reduces tempera- 
ture in fever when applied to the body. 

Internally. — Fat is a normal and necessary constituent of the 
body. It is the fuel used to supply force, and those tissues and 
organs which are the most energetic require the most fat. Conse- 
quently, nerves, muscles, and glands are more abundantly fur- 
nished with fat than cartilage, and in cases of starvation those 
structures demanding the greater supply must have it, at the ex- 
pense of the less highly organized and active tissues — as is seen in 
the great emaciation preceding the decline of mental powers. The 
blood contains about one-half of i per cent, of fat ; the muscles, 3 
per cent. ; the brain, 8 per cent. ; and the nerves 22 per cent. In 
order, therefore, that the various cells of the body may possess 
sufficient vitality to withstand by physiological resistance the en- 
croachments of disease and the invasion of pathogenic micro-or- 
ganisms, this equilibrium must be maintained. Yet this necessary 
food, fat, is more frequently deficient than any other, from the 
difficulty either of obtaining a supply or of digesting and assimi- 
lating it. 

Dr. Hughes Bennett was near the truth in observing that " the 
main causes of tuberculosis are the dearness of butter and the 
abundance of pastry-cooks," intimating that the poor and underfed 
are unable to obtain sufficient fat, while the digestion of the 
wealthy class is deranged by pastries, so that they are unable to 
assimilate a proper amount of fat. 

Dr. Brunton cites the case of a barrister who before pleading a 
case invariably took a full dose of cod liver oil, believing that it 
rendered his mind more active. 

Before oils or fats can enter the various cells and act as food, 
and consequently a source of power, they must be digested and 
assimilated by the system. The value of an oil is based upon — (i) 



136 A TEXT-BOOK OF MATERIA MEDICA. 

Its rate of absorption ; (2) its rate of oxidation ; (3) its agreeable 
taste. 

Cod liver oil, while to many persons repugnant in taste, is more 
readily absorbed and oxidized than any other fat. It has already 
been prepared by the liver, and therefore partly elaborated, and, 
owing to the biliary salts which it contains, it passes more readily 
through animal membranes. Moreover, Naumann has shown that 
cod liver oil is more easily oxidized than any other oil, rendering 
this substance almost an ideal ready-made food. Its actions upon 
the several systems are here considered. 

Digestive System. — Large doses disturb the stomach and may 
even occasion vomiting, but in medicinal doses alone, or in the 
form of an emulsion, it may be taken usually without discomfort, 
in some cases even increasing the appetite. In the stomach cod- 
liver oil is unaffected, but in the intestines it meets the pancreatic 
juice, which resolves a portion of it into glycerin and fatty acids, 
the latter combining with the alkahes of the bile and the intes- 
tinal juice to form soaps, while the remaining, and larger, por- 
tion is emulsionized by the alkaline secretions of the intestines. 

Circulatory System. — The number of red corpuscles is increased 
and the quality of the blood is greatly improved. 

Nervous System. — This shares with the other tissues of the body 
the general amelioration, the drug being a food and tonic to the 
brain and nerves. 

Respiratory System. — No special action is noticeable other than 
the natural improvement in the respiratory power incidental to 
better blood and an increased functional activity of the nerves and 
muscles. 

Absorption and Elimination. — Cod liver oil can be absorbed only 
after it enters the intestines. The glycerin and fatty acids formed 
by the pancreatic juice are readily absorbed by the mucous mem- 
brane, together with the soaps produced by the action of the bile 
and the intestinal juice. 

The oil remaining, as has been stated, is emulsionized — that is, 
it is subdivided into minute globules each enclosed in an envelope 
composed of alkaline albuminate and soap, which has a great 
affinity for the mucous membrane and carries the oil through the 
columnar epithelium of the intestinal villi into the lymph-spaces. 
The osmosis inward of the oil-emulsion is rendered still easier by 
the action of the bile with which the mucous membrane is 
bathed. 



FATS AND OILS. \2yl 

Oils and fats which are absorbed and not needed for cell-food 
are deposited beneath the skin as subcutaneous fat, serving as a 
protection against external cold as well as a reserve supply in case 
the economy needs more fat than can be taken into the system 
and assimilated. The weight, therefore, is usually greatly increased 
under the administration of cod liver oil. 

It will be seen that much of the oil taken into the system is 
oxidized, being subsequently excreted as carbonic acid and water. 

Temperature. — When taken internally the temperature is unaf- 
fected, but, as has been observed, when appHed to the epidermis 
the bodily heat is reduced. 

Untoward Action. — In addition to disturbances of digestion 
sometimes occasioned by moderate doses, cod liver oil at times 
produces a vesicular eczema which may spread over the entire 
body. This eruption is probably caused by the volatile fatty acids 
which the oil contains. 

Poiso7iing. — Cod liver oil possesses no poisonous action. 

Therapeutics. — Externally and Locally. — Cod liver oil is much 
used by dermatologists in diseases of the skin, being especially ser- 
viceable in softening the crusts of eczema. It has been applied to 
the skin to allay irritatiofi and for the reduction of temperature in 
the exanthe^nata. In cases of marasmus and rachitis, and in wasting 
diseases generally, it is a valuable remedy to sustain the vital 
energy and improve nutrition, the oil being given in the form of 
baths. 

Daily inunctions are beneficial in cJironic scaly skin diseases, 
while a local application to the chest has seemed at times to influ- 
ence favorably the course of pertussis. Local applications have 
also been adopted empirically, and with satisfactory results, in 
clironic rheumatism and rlieumatoid arthritis. 

Internally. — For two or three centuries cod liver oil has been 
used both externally and internally for cJironic rheumatism, but it 
is only since 1841 that it has been employed in the treatment of 
tuberc2dosis. While to-day it does not receive the enthusiastic 
support which attended its introduction in the latter disease, it is 
nevertheless a standard and highly efficacious remedy in the various 
forms of the disorder. It is equally valuable in scroftdous affections^ 
and even more potent in rachitis. Clironic broncJdtis is perhaps 
more frequently relieved by its use than by any other internal 
remedy. Diseases resulting in a7iemia are usually more benefited 
by cod liver oil than by other remedial agents. Clironic arthritis, 



138 A TEXT-BOOK OF MATERIA MEDIC A. 

fistula, and abscess in the neighborhood of the joints have been 
greatly improved by its use. Atheroma of the arteries and many 
cutaneous diseases, particularly the strumous variety, and syphilo- 
dermata yield to its alterative and nutrient properties. 

Probably no single drug is employed in nervous diseases with 
effects so markedly beneficial as those of cod liver oil. While 
possessing no specific action, it increases the strength and vitality 
of the patient, enabling him to resist morbid tendencies more suc- 
cessfully, and, by augmenting the force-producing material and 
improving the condition of the nerves, lessens the liability to 
nervous derangement. 

Diabetes mellitus and Bright' s disease, with anemia yet unat- 
tended by marked digestive disturbance, are decidedly improved 
by the administration of cod liver oil. 

Should no gastric disorder supervene, this remedy should invari- 
ably be given in the last-named diseases. It certainly serves to 
maintain the general health, and is singularly eflficacious in pro- 
longing the lives of the afflicted patients, enabling them to profit 
by hygienic measures, upon which great reliance should be placed. 
The tonic and nutritive properties of the drug have been strikingly 
shown in the rapid improvement of patients convalescing from 
acute diseases. In catarrhal conditions, especially in ozena and otitis' 
following measles and scarlet fever, it is of marked benefit. 

Without entering upon specific considerations other than the 
above, it will be seen that cod liver oil is indicated whenever there 
is defective activity, whether inherited or acquired. 

Contraindications. — It is to be remembered that cod liver oil 
is a food and not a medicine : it is therefore contraindicated in all 
diseases where it proves detrimental to the appetite, causing eruc- 
tation, heartburn, diarrhea, etc. It is usually contraindicated in 
fevers, owing to the suspension of the secretions and impairment 
of digestion characteristic of acute febrile disorders. 

Administration. — In the early use of cod liver oil it is advis- 
able to prescribe small doses, that its toleration by the stomach 
may be gradually acquired. To many patients, however, it is ex- 
tremely distasteful, and the repugnance is increased rather than 
lessened by continued use. In such cases it is better, if possible, 
to disguise the taste and smell in some manner rather than to 
abandon so valuable a remedy when clearly indicated. Various 
means have been employed for this purpose. An emulsion may 
be made which obviates its disagreeable qualities. There are in 



MINERAL ACIDS. 139 

the market soft capsules containing this oil that serve an excellent 
purpose, being easily swallowed and disguising completely the 
taste and odor of the drug. Administration should occur ordi- 
narily some time after meals, that the oil may reach the intestines 
as soon as possible. 



GROUP III.— MINERAL ACIDS. 

Mineral Acids are classed here as Restorative Medicines, be- 
cause some of them appear in the normal secretion from certain 
glands, as, for instance, the gastric glands and in the perspira- 
tion and urine. Sulphuric and nitric acids are not normal 
constituents of the body, and are by some authors classed as 
escharotics, although the action and medical uses of these inor- 
ganic acids will here be considered. There are, however, certain 
characteristics common to all mineral acids which claim primary 
attention : 

1. Concentrated mineral acids are caustic to a greater or less 
degree. 

2. They combine with alkalies and alkaline earths to form salts, 
and unite with vegetable acids, setting them free from their com- 
bination with bases. 

3. When in contact with the tissues of the body they combine 
with the protoplasm, neutralizing the alkalies which the latter con- 
tains and forming mineral salts. They also combine with the albu- 
min, forming acid albumin. 

4. Upon the blood they precipitate the albuminous constituents 
•and decompose the hemoglobin. 

5. Acids are said to stimulate the secretion from alkaline 
glands. On the other hand, they depress the secretion from 
acid glands. 

6. They diminish the functional activity of the muscular and 
nervous systems. Applied locally in a concentrated form, or taken 
internally in poisonous doses, they tend to produce rigidity of the 
muscles by coagulating the myosin (Brunton). 

7. The alkalinity of the blood is lessened and the acidity of 
the urine increased by the internal administration of all mineral 
acids. 



140 A TEXT-BOOK OF MATERIA ME DIG A. 

Acidum Hydrochloricum— Acidi Hydrochlorici— 
Hydrochloric Acid. TJ. S. P. 

(Muriatic Acid.) 

Orig-in. — A liquid composed of 3 1.9 per cent, by weight of Abso- 
lute Hydrochloric Acid (HCL=36.37) and 68.1 per cent, of Water. 

Description and Properties. — A colorless, fuming liquid, of a 
pungent odor and an intensely acid taste. Fumes and odor disap- 
pear on diluting the acid with 2 volumes of water. Specific grav- 
ity about I.I 63 at 15° C. (59° F.). Miscible in all proportions with 
water and alcohol. Hydrochloric acid should be kept in dark, 
amber-colored, glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum Hydrochloricum Dilutum — Acidi Hydrochlorici Diluti — Diluted 
Hydrochloric Acid (Diluted Muriatic Acid). — Dose, 10-20 minins (0.6-1.2 Cc). 
Formula: Hydrochloric Acid, 100; Distilled Water, 219. Sp. gr. about 1.050. 

Acidum Nitrohydrochloricum — Acidi Nitrohydrochlorici — Nitrohydro- 
chloric Acid. — Dose, 2-5 minims (0.12-0.3 Cc), well diluted. (Described under 
Nitric Acid.) 

Acidum Nitrohydrochloricum Diliitum — Acidi Nitrohydrochlorici Diliiti 
— Diluted Nitrohydrochloric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). (Described 
under Nitric Acid.) 

Acidum Phosphoricum— Acidi Phosphorici— 
Phosphoric Acid. 17. H, JP. 

Origin. — A liquid composed of not less than 85 per cent, by 
weight of Absolute Orthophosphoric Acid (H3P04==97.8) and not 
more than 15 per cent, of Water. 

Description and Properties. — A colorless liquid, without odor, 
but having a strongly acid taste. Specific gravity not below 1.7 10 
at 15° C. (59° F.). Miscible in all proportions with water or alco- 
hol. Phosphoric acid should be kept in glass-stoppered bottles. 

Dose. — The diluted acid only is given internally. 

Official Preparation. 

Acidum Phosphoricum Diliitum — Acidi Phosphorici Diluti (Diluted Phos- 
phoric Acid). — Dose, 5-25 minims (0.3-1.5 Cc). Diluted phosphoric acid contains 
10 per cent, by weight of absolute orthophosphoric acid. 

Acidum Sulphuricum— Acidi Sulphuric!— Sulphuric 

Acid. XT, S. J>. 

Origin. — A liquid composed of not less than 92.5 per cent, by 



MINERAL ACIDS. 141 

weight of Absolute Sulphuric Acid (H2SO4 = 97.8"2) and not more 
than 7.5 per cent, of Water, 

Description and Properties. — A colorless liquid of oily con- 
sistence, inodorous, and very caustic and corrosive. Specific gravity 
not below 1.835 ^t 15° C. (59° F.). Miscible in all proportions 
with water and alcohol, with evolution of so much heat. that the 
mixing requires great caution. Sulphuric acid should be kept in 
glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum Sulphuricum Aromaticum — Acidi Sulphuric! Aromatici — Aro- 
matic Sulphuric Acid. — Dose, 5-20 minims (0.3-1.2 Cc). Formula: Sulphuric 
Acid, 100; Tincture of Ginger, 50; Oil of Cinnamon, I ; Alcohol, to make looo parts. 

Acidum Sulphiiricum Dilutum— Acidi Sulphurici Diliiti — Diluted Sul- 
phuric Acid. — Dose, 5-20 minims (0.3-1.2 Co.). Diluted sulphuric acid contains 
ID per cent, by weight of absolute sulphuric acid. 

Acidum NTtricum— Acidi NTtrici— Nitric Acid. 

77. H, P. 

Origin. — A liquid composed of 68 per cent, by weight of Abso- 
lute Nitric Acid (HNO3 = 62.89) ^^^ 32 per cent, of Water. 

Description and Properties. — A colorless, fuming liquid, very 
caustic and corrosive, and having a peculiar, somewhat suffocating 
odor. Specific gravity about 1.414 at 15° C. (59° F.). Nitric acid 
should be kept in dark, amber-colored, glass-stoppered bottles. 

Dose. — 2-5 minims (0.12-0.3 Cc), well diluted. 

Official Preparations. 

Acidum Nitricum Dilutum— Acidi Nitrici Diluti— Diluted Nitric Acid.— 

Dose, 5-20 minims (0.3-1.2 Co.). Diluted nitric acid contains 10 per cent, by weight 
of absolute nitric acid. 

Acidum Nitrohydrochloricum — Acidi Nitrohydrochlorici — Nitrohydro- 
chloric Acid.— Formula : Nitric Acid, 180; Hydrochloric Acid, 820 parts. 

Description and Properties .— K golden yellow, fuming, and very corrosive liquid, 
having a strong odor of chlorine. Completely volatilized by heat. It readily dissolves 
gold-leaf, and a drop of it added to potassium iodide T. S. liberates iodine. 

Dose. — 1-3 minims (0.06-0. 18 Cc). 

Acidum NitrohydrochlSricum Dilutum — Acidi Nitrohydrochlorici Diluti — 
Diluted Nitrohydrochloric Kzxdi.—Dose, 5-20 minims (0.3-1.2 Cc). Formula: 
Nitric Acid, 40; Hydrochloric Acid, 180; Distilled Water, 780 parts. 



Antagonists and Incompatibles. — Hydrochloric acid and its 
preparations are incompatible (forming explosive compounds) with 



142 A TEXT-BOOK OF MATERIA MEDICA. 

oxidizable substances — phosphorus, sulphur and the sulphides, 
alcohols, ethers, carbohydrates, etc. All the mineral acids are in- 
compatible with the alkalies and their carbonates, salts of lime, 
lead, and silver, and decompose glucosides. 

Synergists. — The action of hydrochloric acid upon the diges- 
tive system is aided by the digestive ferments and the vegetable 
bitters. 

Physiolog'ical Action. — The general action of mineral acids 
upon the various systems is herewith given in detail : 

Externally and Locally. — Applied in a concentrated form to the 
skin or to any tissue of the body, acids abstract the water from 
'the tissues and destroy the protoplasm, acting as escharotics. 
Weaker solutions vesicate, merely inflaming the parts to which they 
are applied, without destroying the tissue, while extremely diluted 
or weak solutions are irritant and astringent. 

Internally. — Digestive System. — Diluted acids only should be 
administered internally. Save with reference to the poisonous 
effects of concentrated acids, therefore, the physiological action of 
diluted acids only will be here considered. 

^ The salivary glands are stimulated, resulting in an increased flow 
of saliva, moistening the mouth and allaying thirst. The appetite 
and digestion are improved, and the secretions from the liver and 
the duodenal glands are increased. Long-continued use of the 
mineral acids impairs digestion by lessening the normal secretion 
of the gastric glands, while protracted use may produce salivation. 
Mineral acids tend to constipate the bowels. 

Circulatory System. — Diluted acids in medicinal doses cause a 
rise in blood-pressure, and increased action of the heart, prob- 
ably due to their stimulating action on the vaso-motor mechanism. 
Concentrated acids relax the muscular tissue of both the heart 
and blood-vessels. Mineral acids combine with the albumin or 
the alkaline bases of the blood, lessening the alkalinity of that 
fluid. 

Nervous System. — Medicinal doses, so far as observed, produce 
no special action upon the nervous system other than to occasion 
a slight stimulation of the brain, due probably to a gentle arterial 
excitement. 

Respiratory System. — No important action under medicinal doses 
has been observed. 

Absorption and Elimination. — Mineral acids, above all hydro- 
chloric acid, are readily absorbed. They are quickly converted 



MINERAL ACIDS. 143 

into neutral salts in the intestines, and are absorbed as such. The 
excess of the acid which does not enter into combination in 
the stomach and intestines is rapidly absorbed into the blood, com- 
bining with its alkaline bases, and in this form is excreted, princi- 
pally by the kidneys, as acid salts. 

Temperature. — Medicinal doses have no influence upon temper- 
ature. 

Untoward Action. — Mineral acids under too prolonged admin- 
istration impair the appetite and disturb digestion, occasioning 
toothache and gastric oppression, and at times salivation and diar- 
rhea. The prolonged use of nitric acid may produce erosion of 
the gums and tongue, with loosening of the teeth. 

Poisoning. — The mineral acids when taken in a concentrated 
form and in toxic doses act like corrosive poisons, causing intense 
burning in the stomach and intestines and active gastric inflamma- 
tion. Violent vomiting occurs, the ejected matter containing blood, 
and, in the case of hydrochloric acid, a white cloud of ammonium 
chloride is discerned if the ejecta be placed near the vapor of 
ammonia. 

The respiration is greatly depressed, and there is a strong, 
persistent acid taste in the mouth, the mucous membrane of 
which is discolored, while the tongue is swollen and inflamed. 
There is great thirst, and the pulse becomes rapid and tense. 
The temperature, at first elevated, soon falls below normal, pro- 
found prostration supervening, and death resulting either from 
shock or from secondary inflammation. 

A post-mortem examination shows the results of corrosive poi- 
soning: ulceration or evidences of intense inflammation of the 
mucous membrane of the mouth, esophagus, stomach, and intes- 
tines. Occasionally the walls of the latter are perforated. Should 
death be delayed for some time, there is found fatty degeneration 
of the kidneys and other internal organs. 

Treatment of Poisoning. — This should be prompt. The cautious 
administration of alkalies is indicated to neutraKze the acid, though 
the evolution of carbonic-acid gas resulting therefrom may rupture 
the stomach. The stomach should be washed out, and this treat- 
ment followed by demulcent drinks and oil, milk, and eggs. 
Opium may be necessary for the rehef of pain, and brandy or 
whiskey subcutaneously in case of collapse. 

Therapeutics. — Externally and Locally. — Hydrochloric acid 
is employed as a caustic in noma and putrid sore throat. Mixed 



144 ^ TEXT-BOOK OF MATERIA MEDIC A. 

with two or three parts of honey, it is an efficient application to> 
the throat in diphtheria. Andrews and Morris have recommended 
diluted hydrochloric acid for the removal of sequestra, and Chas- 
saignac has utihzed the acid in removing necrosed bone in osteitis 
and caries. 

Nitric acid is a much more powerful caustic, and as such is 
used more extensively than any other mineral acid, because of its 
limited action and the ease with which it is controlled. It is an 
excellent caustic in cases of cancer of the cervix, venereal warts^ 
hospital gafigrene, phagedenic tdceration, hemorrhoids, and prolapse 
of the rectum, especially in the case of children. In cases also 
of fungoid grafiulatiojt and excessive hemorrhage from the uterus^ 
it has been highly recommended. In certain diseases of the 
throat, nose, and ear this acid has been used for the destruction 
of growths, as well as for its escharotic action in ulcerated 
conditions. 

Dermatologists find nitric acid to be an efficient appHcation for 
the removal and destruction of epithelioma, 7noles, nevi, chloasma^ 
etc., caution being exercised in the latter case merely to produce 
an exfoliation of the skin, not sufficient destruction of tissue ta 
result in a cicatrix. 

Liveing recommends a veiy weak solution of nitric acid with 
tincture of opium in pruritus. 

Phosphoric acid, in the strength of 50 grains (3.2) to the ounce 
(30.0 Cc.) of distilled water, has been suggested by Grossich in the 
treatment of scrofidous ulcers, and an injection of this solution into 
tuberctdous glands of the neck is highly recommended by the same 
authority. 

Sulphuric acid is perhaps the most persistent, irritating, and 
destructive caustic known. Its affinity for water, and its consequent 
extensive action, render it when used alone unfit for caustic pur- 
poses. Mixed with powdered charcoal, however, it forms a paste 
which is an efficient caustic application to chancres, cajicers, etc. 
Frazer considers the strong sulphuric acid the best caustic in 
the bites of rabid animals. Diluted solution, in the proportion of 
6 parts of the strong acid to 4 parts of diluted alcohol, has been 
recommended for epistaxis. 

Internally. — Hydrochloric acid, being a normal constituent of 
the stomach, is indicated in certain forms of gastric dyspepsia, par- 
ticularly in the atonic variety. In these latter cases there is usually 
decomposition and fermentation of food, which condition is greatly 



MINERAL ACIDS. 145 

relieved by the administration of pepsin or hydrochloric acid after 
meals, or the same with bitters before meals. 

In intestinal indigestion hydrochloric acid is an admirable rem- 
edy, given one or two hours after meals. 

The diluted hydrochloric acid is a valuable internal remedy in 
the treatment of diphtheria, and during the course oi fevers, par- 
ticularly typhoid. As a routine treatment in the latter disease the 
author almost invariably gives hydrochloric acid in connection with 
pepsin, finding that it not only allays thirst and moistens the tongue, 
but exerts an antiseptic influence in the bowels, thereby lessening 
the danger of auto-infection and relapse. Alkiewicz recommends 
weak solutions of hydrochloric acid as efficacious in natisea and 
vomiting accompanying certain infectious diseases. 

In certain affections of the skin dependent upon deranged diges- 
tion hydrochloric acid often proves a potent remedy. 

Nitric acid has been used for the same purposes as hydro- 
chloric acid, although for digestive disorders it is inferior to the 
latter drug. 

In intermittent and periodical fevers, however, nitric acid is an 
efficient remedy. In hepatic disorders the diluted nitrohydrochloric 
acid deservedly holds a high place as a remedial agent, and the same 
remedy is frequently employed with success in chronic syphilis. 

In the conditions known as oxaluria and lithemia nitric and 
nitrohydrochloric acids serve an excellent purpose. 

The invaluable preparation introduced by Dr. Hope in 1826, 
known as " Hope's camphor mixture " — a combination of nitrous 
acid, camphor-water, and tincture of opium — has never been sur- 
passed as a remedy in serous diarrhea. 

The aphonia of singers and public speakers is often relieved by 
the diluted nitric acid, certain cases of broncJdtis being also bene- 
fited by the same remedy. 

Melancholia and the hypochondriasis of dipsomaniacs are some- 
times relieved by diluted nitrohydrochloric acid. 

Phosphoric acid has acquired some reputation as a remedy 
in a7ie7nia and as a tonic in wasting diseases and neurasthenia. Its 
value, however, is based more upon theory than upon the results 
of clinical observation. The experience of the author warrants 
the assumption that phosphoric is inferior to hydrochloric acid in 
these conditions, its action being entirely due to increasing diges- 
tion and thereby improving nutrition. 

Probably phosphoric acid is superior to the other mineral acids 
10 



146 A TEXT-BOOK OF MA TERIA MEDICA. 

only in its action in diabetes, in which disease it certainly possesses 
a remarkable influence in diminishing thirst and lessening the 
secretion of urine. 

Sulphuric acid, in the author's opinion, is inferior to nitric or 
nitrous acid in serous diarrhea. It is nevertheless an invaluable, as 
well as an old and tried, remedy in cholera^ the statistics furnished 
by the Insane Department of the Philadelphia Almshouse during 
an epidemic of this disease appearing to prove its efficacy, 
t This remedy also deserves favorable consideration in the treat- 
ment of acute lead-poisoning. Moreover, in chronic lead-poisoning 
water acidulated with sulphuric acid makes an efficient prophylactic, 
and the remedy has also been suggested as a preventive of Asiatic 
cholera. 

Owing to its astringent and antiseptic properties this acid, par- 
ticularly the aromatic sulphuric acid, proves a good remedy in cer- 
tain cases of diarrhea. It is especially valuable in checking the 
sweating in phthisis. The same preparation has been found bene- 
ficial m hematemesis, as well as in i?itestinal and uterine hemorrhage. 

Where there is a tendency to dissolution of the blood, as in 
scurvy and purpura, sulphuric acid has proved valuable, and it has 
been recommended as an internal remedy in lichen, prurigo, and 
many itching diseases of the skin. 

Contraindications. — Acute inflammation of the stomach, rheu- 
matism, gout, and where the urine is excessively acid and of high 
specific gravity. 

Administration. — Only the diluted acids should, be given in- 
ternally, and even these should be further diluted, and taken, if 
possible, through a glass tube, to prevent injury to the enamel of 
the teeth. They should not be administered for too long a period, 
and the first indication of untoward action, such as griping, diar- 
rhea, etc., is to be taken as a warning that the drug must be with- 
drawn. 

Acidum Lacticum— Acidi Lactici— Lactic Acid. 

Origin. — An organic acid usually obtained by subjecting milk 
sugar or grape sugar to lactic fermentation. It is composed of 75 
per cent, by weight of Absolute Lactic Acid (CHC3H503= 89.79) 
and 25 per cent, of Water. 

Description and Properties. — A colorless, syrupy liquid, 
odorless, of a purely acid taste, and absorbing moisture on ex- 



MINERAL ACIDS. 147 

posure to damp air. Specific gravity about 1.2 13 at 15° C. (59° 
F.). Freely miscible with water, alcohol, or ether; insoluble in 
chloroform, benzin, or carbon disulphide. 

Dose. — 20-30 minims (1.2-1.8 Cc), diluted and sweetened. 

Official Preparation. 

Syrupus Caicii Lactophosphatis — Syrupi CSlcii Lactophosphatis — Syrup 
of Calcium Lactophosphate. — Dose, 1-2 fluidrachms (3.7-7.3 C), Formula : 
Precipitated Calcium Carbonate, 25 ; Lactic Acid, 60 ; Phosphoric Acid, 36 ; Orange 
Flower Water, 25; Sugar, 700; Water, q. s. ad 1000. 

Antagonists and Incompatibles. — Alkalies and the salts ot 
the mineral acids are incompatible with lactic acid. 

Synergists. — Pepsin, vegetable acids, hydrochloric acid, and 
sodium chloride. 

Physiolog-ical Action. — Externally and Locally. — Lactic Acid is 
a caustic to highly organized tissues, resembling the mineral acids 
in its local action. It dissolves false membrane to which it is 
applied. 

Internally. — Digestive System. — It is generally present in the 
stomach during the first forty-five minutes of stomachic digestion, 
but cannot be considered a normal constituent of the gastric 
juice. 

Circulatory System. — Being absorbed from the stomach, it com- 
bines with bases in the blood, forming lactates which are rapidly 
converted into carbonates. In certain morbid conditions of the 
system, such as acute rheumatism, it is found free in the blood. 

Richardson has produced endocarditis in dogs by injecting 
lactic acid into the peritoneal cavity. Large doses decrease the 
normal alkahnity of the blood. 

Nervous System. — Large doses greatly depress the nervous sys- 
tem, frequently producing neuralgia and myalgia. 

Absorption and Elimination. — It is absorbed from the stomach, 
undergoes a change in the blood, and is eliminated by the kidneys, 
although, according to Lehmann, when large doses have been 
taken it is found in the urine unchanged ; and we have Benzelius 
and Scherer as au^orities that lactic acid can be detected in the 
spleen and the muscular fluid and has been found in the exudates 
of puerperal fever. 

Untoward Action, Poisoning, and Treatment of Poisoniiig are 
similar to those of the mineral acids. 

Therapeutics. — Externally and Locally. — It has been used 



148 A TEXT-BOOK OF MATERIA MEDIC A. 

locally for the same purposes as the mineral acids, but it is 
thought by many clinicans to be superior to the latter in tubercu- 
lous ulceration. In the Hamburg General Hospital, Dr. Zippel 
has employed it with excellent success in the treatment of tubercu- 
lous fistulae. He inserted into the fistula rods made of lactic acid, 
gelatin, and menthol, enveloped with a thin layer of collodion. 

As a solvent of false membranes lactic acid is unquestionably 
superior to the mineral acids, being highly recommended for this 
purpose in diphtheria and croup by such authorities as Morell 
Mackenzie, Lennox Browne, Weber, Bureau, etc. 

Internally. — Digestive System. — It is used in the digestive dis- 
orders, such as atonic and irritative dyspepsia^ and in all those 
derangements of digestion which are benefited by hydrochloric 
acid. In oxaluria^ lithemia, chronic cystitis with ammoniacal urine, 
chronic dysentery, and dyspeptic and tuberctdous diarrhea it has 
proved an efficient remedy. It has been recommended by Dr. 
Foucaut as a prophylactic in gout. 

Since this drug was suggested by Cantani as a remedy in dia- 
betes mellittis it has been used with varying success. Balfour and 
Foster, as well as Cantani himself, have reported many cases 
which have greatly improved under the administraton of lactic acid 
accompanied by an appropriate dietetic regimen. In the continued 
use of this drug for diabetes, however, it is well to remember that 
acute rheumatism and rheumatic endocarditis may be induced, 
endangering the life of the patient even more than the disease for 
which the drug was prescribed. 

Lactic acid has been recommended by Preyer, Mendel, and 
Maragliano as a hypnotic. Yet the authority appears to rest 
rather upon theoretical deduction than the result of cHnical 
observation. 

Contraindications. — The same as for mineral acids. 

Administration. — Lactic acid should be given well diluted. 



GROUP IV.— VEGETABLE ACIDS. 



Acidum Aceticum— Acidi Acetici— Acetic Acid. 

V. S. P. 

Orig-in. — A liquid composed of 36 per cent, by weight of Ab- 
solute Acetic Acid (HC2H302= 59.86) and 64 per cent, of Water. 
Description and Properties. — A clear, colorless Hquid, having 



VEGETABLE ACIDS. 149 

a strong, vinegar-like odor, a purely acid taste, and a strongly acid 
reaction. Miscible with water or alcohol in all proportions. 
Dose. — The diluted acid only is given internally. 

Official Preparation. 

Acidum Aceticum Dilutum — Acidi Acetici Diluti — Diluted Acetic Acid, 

Dose, 1-2 fluidrachms (3.7-7.4 Cc). 

Acidum Citricum— Acidi Citrici— Citric Acid. 

V. S. J>. 

Origin. — An organic acid usually prepared from lemon-juice. 

Description and Properties. — Colorless, translucent, right- 
rhombic prisms ; odorless, having an agreeable, purely acid taste ; 
efflorescent in warm air and dehquescent when exposed to moist 
air. Soluble in 0.63 part Water, in 1.61 parts of alcohol, in about 
0.4 part of boiling water, and in 1.43 parts of boiHng alcohol. 

Dose. — 5-20 grains (0.3-1.25 Gm.). 

Official Preparation. 

Syrupus Acidi Citrici — Syrupi Acidi Citrici — Syrup of Citric Acid. — Dose, 
2-8 fluidrachms (7.4-30. Cc.) (10 per cent.). 

Acidum Tartaricum— Acidi Tartarici— Tartaric 
Acid. 77. >Sf. J». 

Origin. — An organic acid usually prepared from argols. 

Description and Properties. — Colorless, translucent, mono- 
clinic prisms, or crystalline crusts, or a white powder; odorless, 
having a purely acid taste, and permanent in air. Soluble in about 
0.8 part of water and in 2.5 parts of alcohol; also in about 0.5 part 
of boiling water and in 0.2 part of boiling alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 



Antagonists and Incompatibles. — Alkalies are chemically in- 
compatible with the vegetable acids. With the alkaline, earthy, 
and metallic bases vegetable acids unite to form salts, the acetates 
of which are all soluble. 

Synergists. — Alkalies, and, under certain circumstances, mineral 
acids and the digestive ferments. 

Physiological Action. — Externally a7id Locally. — The vege- 
table acids have about the same action externally and locally as the 
diluted mineral acids, not caustic but irritant, acetic acid being the 
most powerful and citric acid the weakest. 



150 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — Digestive System. — Their action on the salivary and 
gastric glands is similar to that of the mineral acids. Their influ- 
ence upon the stomach is not so marked as that of hydrochloric 
acid, though the secretions from the intestinal glands are more 
augmented by vegetable than by mineral acids. Too large or 
prolonged doses of the vegetable acids produce flatulence and 
abdominal pain, and may even occasion diarrhea or enteritis. 

Circulatory System. — Large doses retard and weaken the pulse. 
As with mineral acids, their tendency is to lessen the alkalinity of 
the blood. They unite with alkalies in the stomach to form salts, 
and as such enter the blood, where they are oxidized, the product 
being carbonic acid, which lessens the alkalinity of the blood and 
increases the acidity of the urine. 

Absorption and Elimination. — As stated, vegetable acids unite 
with the alkalies to form salts, as such entering the circulation. 
They are eliminated chiefly by the kidneys, increasing the excre- 
tion of both water and solids. Elimination also takes place to a 
considerable extent by the intestinal canal. 

Untoward Action. — Under prolonged dosage there is great ema- 
ciation, deterioration of the blood, and a scorbutic condition. 

Poisoning. — Their toxic effects are almost identical with those 
of the mineral acids, the Treatment of Poisoning being the same 
as with the latter. 

Therapeutics. — Externally and Locally. — All the above-named 
vegetable acids are irritant, more or less antiseptic, and hemo- 
static, ACETIC ACID being the most powerful antiseptic of the three. 
Englemann regards acetic acid as superior to mercuric chloride as' 
a disinfectant in obstetrical practice, employing a solution of from 
3 to 5 per cent, for this purpose. A diluted solution is a valuable 
injection in gonorrhea of the female. The glacial acetic acid is a 
powerful caustic, and is much used to dissolve horny growths, warts, 
corns^ etc. 

The most important use of acetic acid is in the treatment of 
certain parasitic skin diseases, probably no remedy excelling it in 
cases of ringworin and pityriasis. Diluted acetic acid, or vinegar, 
is an efficient gargle in simple sore throat and the last stage of 
angincB of exanthemata, as well as a valuable hemostatic, espe- 
cially in epistaxis. 

Citric acid is but little used locally, although solutions have 
been employed with some success to relieve the itching and sting- 
ing of "prickly heat" and urticaria. A sponge-bath of vinegar 



ALKALIES. 151 

and water is a grateful and efficient means of rcdticing temperature 
and checking excessive sweating in disease. 

Tartaric acid has been used by Potter as an application to 
the throat in diphtheria, the effect being to convert the membrane 
into a gelatinous mass which is more easily expelled. 

Internally. — Acetic acid is little used internally. Citric acid, 
however, in the form of a lemonade, is a refreshing refrigerant 
drink mfevei''s, while a similar hot lemonade taken at bedtime is a 
valuable and agreeable means of aborting a " cold." Lemon- or 
Hme-juice is an infallible prophylactic against scurvy, being unques- 
tionably the most efficient remedy for the disease. 

It is well known by the laity that eating lemons increases the 
functional activity of the liver. Lemons and citric acid, there- 
fore, are efficient remedies in relieving attacks of biliousness and 
catarrlial jaimdice, and they even appear to counteract the effects 
of malaria. Lemon-juice is an old and esteemed remedy in acute 
rheumatism. 

Vegetable acids are used for the same disorders of the digestive 
tract as mineral acids, although not so efficient as the latter, espe- 
cially the hydrochloric. Much of the benefit derived from sour 
table-wines is due to the fruit-acids they contain. 

Contraindications. — Ordinarily the same as for mineral acids. 
It is a matter of observation that nursing mothers may produce a 
troublesome diarrhea in the infant by partaking too freely of vine- 
gar or acid fruits. 

Administration. — ^-A solution of citric acid may be made of 
about the acidity of lemon-juice by dissolving 570 grains (36.93 
Gm.) in i pint (473.17 Cc.) of distilled water. Vegetable acids 
when taken internally should be mixed with, or dissolved in, water 
and diluted and sweetened, that they may be pleasant to the taste 
and acceptable to the stomach. 



GROUP v.— ALKALIES. 



Alkalies are classed as Restoratives because the blood and many 
secretions of the body are normally alkaline in reaction. The fol- 
lowing drugs are numbered among alkahes or antacids : Liquor 
potassae, potassii acetas, potassii bicarbonas, potassii bitartras, 
potassii carbonas, potassii citras, potassii tartras, liquor sodse, sodii 



152 A TEXT-BOOK OF MATERIA MEDICA. 

acetas, sodii bicarbonas, sodii carbonas, sodii carbonas exsiccatus, 
calcii carbonas praecipitatus, creta preparata, liquor calcis, mistura 
cretae, syrupus calcis, lithii benzoas, lithii carbonas, lithii citras, 
lithii citras effervescens, lithii salicylas, magnesii carbonas, ammonii 
carbonas, spiritus ammonise aromaticus. 

Liquor Potassae— Liquoris Potassae— Solution of 
Potash. U.S. I". 

Orig-in. — An aqueous solution of Potassium Hydrate containing 
about 5 per cent, of the Hydrate. 

Description and Properties. — A clear, colorless liquid, odor- 
less, having a very acrid and caustic taste and a strongly alkaline 
reaction. It should conform to the same reaction and tests as an 
aqueous solution of potassa. (See Potassa.) 

Dose. — 5-20 minims (0.3-1.2 Cc), well diluted. 

Potassii Acetas— Potassii Acetatis— Potassium 
Acetate. TI. S. P. 

Origin. — Prepared by the action of Acetic Acid upon Potassium 
Carbonate. 

Description and Properties. — A white powder or crystalline 
masses, of a satiny lustre, odorless, and having a warm, saline 
taste ; very deliquescent on exposure to the air. Soluble in 0.36 
part of water and in i .9 parts of alcohol ; with increasing tempera- 
ture it becomes much more soluble in both liquids. Potassium 
acetate should be kept in well-stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Potassii Bicarbonas— Potassii Bicarbonatis— Po- 
tassium Bicarbonate. JJ. S. P. 

Origin. — Prepared by the action of Carbon Dioxide upon a 
solution of the Carbonate. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, odorless, and having a saline and sHghtly alkaline 
taste. Permanent in the air, soluble in 3.2 parts of water at 15° C. 
(59° F.) and in 1.9 parts at 50° C. (122° F.). At a higher temper- 
ature the solution rapidly loses carbon dioxide, and, after boiling, 
contains only potassium carbonate. It is almost insoluble in 
alcohol. The drug should be kept in well-stoppered bottles. 

Dose. — 10-40 grains (0.6-2.5 Gm,). 



ALKALIES. 153 

Potassii Bitartras— Potassii Bltartratis— Potassium 
Bitartrate. V. S. I". 

(Cream of Tartar.) 

Origin. — Prepared by purifying and crystallizing Argol or Crude 
Tartar, a residuum of grape-juice after fermentation. 

Description and Properties. — Colorless or slightly opaque, 
rhombic crystals, or a white, somewhat gritty powder, odorless, 
and having a pleasant, acidulous taste ; permanent in the air. Sol- 
uble in about 200 parts of water and in about 16.7 parts of boiling 
water ; very slightly soluble in alcohol. 

Dose. — 10 grains— |- ounce (0.6-16.0 Gm.). 

Official Preparatio7i. 

Ptilvis Jalapae Compdsitus — Piilveris Jalapse Comp6siti^Compound Pow- 
der of Jalap. — Dose, 10-30 grains (0.6-2.0 Gm.) ; used as a hydragogue cathartic. 

Potassii Carbonas— Potassii Carbonatis— Potas- 
sium Carbonate. TJ, S. JP. 

Origin. — Prepared from the ash obtained from the residue of the 
beet-sugar manufacture. It may also be obtained from wood-ashes. 

Description and Properties. — A white, granular powder, odor- 
less, and having a strongly alkaline taste ; very deliquescent ; solu- 
ble in I.I parts of water at 15° C. (59^ F.) and in about 0.65 part 
of boiling water; insoluble in alcohol. Its aqueous solution (i in 
20) has a strongly alkaline reaction upon litmus-paper, and effer- 
vesces with acids. Potassium carbonate should be kept in well- 
stoppered bottles. 

Dose. — 5-30 grains (0.3-2.01 Gm.). 

Potassii CTtras— Potassii Citratis— Potassium 
Citrate. U. S. JP. 

Origin. — Prepared by the action of Citric Acid upon a solution 
of Potassium Carbonate. 

Description and Properties. — Transparent, prismatic crystals, 
or a white, granular powder, odorless, and having a cooling, saline 
taste ; deliquescent on exposure to the air. Soluble in 0.6 part of 
water at 15° C. (59° F.), and very soluble in boiling water; feebly 
soluble in alcohol. Potassium citrate should be kept in well-stop- 
pered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 



154 A TEXT-BOOK OF MATERIA MEDICA. 

Potassii Tartras— Potassii Tartratis— Potassium 
Tartrate. (Unofficial.) 

Origin. — Prepared by the action of Acid Potassium Tartrate 
upon Potassium Carbonate. 

Description and Properties. — It occurs usually in the form of 
a granular or fine white powder, inodorous, and of a sahne, bitter- 
ish taste. Soluble in 0.75 part of water at 2° C. (35.6° F.), and in 
0.47 part of water at 64^ C. (147.2° F.). 

Dose. — 30 grains-^ ounce (2.0-16.0 Gm.). 

PREPARATIONS OF SODIUM. 

Liquor Sodae— Liquoris Sodae— Solution of Soda, 

U.S.JP. 

(Solution of Sodium Hydrate.) 

Origin. — An aqueous solution of Sodium Hydrate (NAOH = 
39.96), containing about 5 per cent, of the Hydrate. 

Description and Properties. — A clear, colorless liquid, odor- 
less, having a very acrid and caustic taste and a strongly alkahne 
reaction. 

Dose. — 5-20 minims (0.3-1.8 Cc). 

S5dii Acetas— Sodii Acetatis— Sodium Acetate- 

77. S. IP. 

Origin. — It may be obtained by neutralizing Acetic Acid with 
Sodium Carbonate. The usual article, however, is manufactured on 
a large scale in the United States in the process of purifying acetic 
acid from wood vinegar. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or a granular, crystalline powder, odorless, and having 
a cooling, saline taste ; efflorescent in warm, dry air. Soluble in 
1.4 parts of water and in 30 parts of alcohol; also in 0.5 part of 
boiling water and in 2 parts of boiling alcohol. Sodium acetate 
should be kept in well-stoppered bottles. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Sodii Bicarbonas— Sodii Bicarbonatis— Sodium 
Bicarbonate. 77. S. jP. 

Origin. — Prepared by saturating a mixture of 2 parts of Crys- 
tallized and 3 parts of Dried Sodium Carbonate with Carbon Diox- 



ALKALIES. 155 

ide, generated by the action of hydrochloric acid upon marble. 
The damp Salt formed is shaken with half its weight of Distilled 
Water, the undissolved portion being dried by exposure to the air. 

Description and Properties. — A white, opaque powder, odor- 
less, and having a cooling, mildly alkaline taste ; permanent in dry, 
but slowly decomposed in moist, air. Soluble in 11.3 parts of 
water at 15° C. (59° F.) ; above that temperature the solution loses 
carbon dioxide, and at a boiling heat the salt is entirely converted 
into normal carbonate. Insoluble in alcohol and ether. The drug 
should be kept in well-closed vessels, in a cool place. 

Dose. — 10-30 grains (0.6-2.0 Gm,). 

Official Preparations. 

Mistura Rhei et Sodse — Misturse Rhei et Sodae — Mixture of Rhubarb and 
Soda. — Dose, \-2 fluidounces (7.4-59 Cc). 

Trochisci Sodii Bicarbonatis — Trochiscos (ace.) Sodii Bicarbonatis — 
Troches of Sodium Bicarbonate. — Dose, i to 6 troches. 

Sodii Carbonas— Sodii Carbonatis— Sodium 
Carbonate. V. S. JP. 

Origin. — Obtained from Sodium Sulphate and Sodium Chloride, 
but chiefly by a compHcated process, known as Leblands, from 
Sodium Sulphate, which is mixed with Chalk and Coal, the mixture 
ignited, and the resultant mass exhausted with Water and concen- 
trated, the carbonate separating from the hot liquid being purified. 

Description and Properties. — Colorless, monoclinic crystals, 
having a strongly alkaline taste. In dry air the salt effloresces, 
and if left exposed soon loses about half its water of crystallization 
(31.46 per cent, of its weight), becoming a white powder. Soluble 
in 1.6 parts of water at 15° C. (59° F,), in 0.09 part at 38° C. 
(100.4° F-)' ^" 0.2 part of boiling water, and in 1.02 parts of glycerin ; 
insoluble in alcohol and ether. The aqueous solution gives an 
alkaline reaction with litmus-paper, and effervesces strongly with 
acids. The drug should be kept in well-closed vessels. 

Dose. — 10-30 grains (.06-2.0 Gm.). 

Official Preparation. 

Sodii Carbonas Exsiccatus — Sodii Carbonatis Exsiccati — Dried Sodium 
Carbonate. — Description and Properties. — A loose white powder, conforming to the 
reactions and tests for sodii carbonas. 

Dose. — 3-10 grains (0.2-0.6 Gm.). 



J 56 A TEXT-BOOK OF MATERIA MEDIC A. 



PREPARATIONS OF CALCIUM. 

Calcii Carbonas Praecipitatus— Calcii Carbonatis 
Praecipitati— Precipitated Calcium Carbonate. 
JJ. S. JP. 

Orig-in. — Prepared by mixing aqueous solutions of Calcium 
Chloride and Sodium Carbonate, the resulting precipitate of Cal- 
cium Carbonate being purified. 

Description and Properties. — A fine white powder, without 
odor or taste, permanent in the air. Nearly insoluble in water, its 
solubility being increased by the presence of ammonium salts, and 
especially by carbonic acid, and diminished by alkali hydrates. 
Insoluble in alcohol, but in diluted acetic, hydrochloric, or nitric 
acid completely soluble, with effervescence. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Creta Praeparata— Cretae Praeparatae— Preparea 
Chalk. U.S.JP. 

Origin. — Native, friable Calcium Carbonate freed from most im- 
purities by elutriation. 

Description and Properties. — A white, amorphous powder, 
often moulded into conical drops, odorless and tasteless, permanent 
in the air. Almost insoluble in water ; insoluble in alcohol ; soluble 
in diluted acetic, hydrochloric, or nitric acid, with copious efferves- 
cence, but without leaving more than a trifling residue. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Hydrargyrum cum CretS— HydrSrgyri cum Greta — Mercury with Chalk. — 

Dose, 2-10 grains (0.12-0.6 Gm.). (Described under Hydrargyrtcm.) 

Piilvis Cretse CompSsitus — Ptllveris Cretae CompSsiti —Compound Chalk 

Powder. — Dose, 20-60 grains (1.30-4.0 Gm.). 

Trochlsci Cretse — Trochiscos (ace.) Cretae — Troches of Chalk. — Dose, ad 

libitum. 

Unofficial Preparations. 

Piilvis Cretae Aromaticus — Ptilveris Cretae Arom^tici — Aromatic Powder 
of Chalk. — Dose, 30-60 grains (2.0-4,0 Gm.). A mixture of Aromatics with 
Chalk. 

Piilvis Cretae Aromaticus cum Opio — Ptilveris Cretae AromStici cum Opio 
— Aromatic Powder of Chalk and Opium.— Z>cj-^, 10-20 grains (0.6-1.30 Gm.). 
I grain (.06 Gm.) of Opium in every 40 grains (2.5 Gm.) of the previous mixture. 



ALKALIES. 157 

Liquor Calcis— Liquoris Calcis— Solution of Lime. 

77. S. jP. 

(Solution of Calcium Hydrate; Lime Water.) 

Orig-in. — A saturated, aqueous solution of Calcium Hydrate. 

Description and Properties. — A clear, colorless liquid, without 
odor, and having a saline and feebly caustic taste. It absorbs 
carbon dioxide from the air, so that a pellicle of calcium carbonate 
forms on the surface of the liquid. On being heated it becomes 
turbid through separation of calcium hydrate, which redissolves 
when the liquid is cooled. It gives a strong alkaline reaction with 
litmus paper. 

Dose. — ^-4 ounces (15.0-118.3 Cc). 

Official Preparatio7is. 

LinimSntum Caicis — LinimSnti Caicis — Lime Liniment (Carron Oil). — 
For external use. 

Mistura Cretae — Misturse Cretse — Chalk Mixture. — Dose, 1-4 fluidrachms 
(4.0-15. Cc). Compound Chalk Powder, Cinnamon Water, and Water. 

Sj^rupus calcis — Syrupi Calcis — Syrup of Lime. — Dose^ \-2 fluidrachms 
(1.8-7.4 Cc). 

PREPARATIONS OF LITHIUM. 

LTthii Carb5nas— Lithii Carbonatis— Lithium 
Carbonate. JJ. S, J*. 

Origin. — Lithium, is found in many mineral waters, the carbon- 
ate being prepared from lepidolite. 

Description and Properties. — A light white powder, odorless, 
and having an alkaline taste ; permanent in the air. Soluble in 80 
parts of water and 140 parts of boiling water ; much more soluble 
in water saturated with carbon dioxide ; insoluble in alcohol, but 
soluble in diluted acids, with active effervescence. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Lithii Citras— Lithii Citratis— Lithium Citrate. 

U. S. J>. 

Origin. — Prepared by adding Lithium Carbonate to a solution 
of Citric Acid. 

Description and Properties. — A white powder, odorless, and 
having a cooling, faintly alkaline taste ; deliquescent on exposure 
to the air. Soluble in 2 parts of water and in 0.5 part of boiling 



158 A TEXT-BOOK OF MATERIA MEDICA. 

water ; almost insoluble in alcohol or ether. Lithium citrate should 
be kept in well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Preparation. 

Lithii Citras EffervSscens — Lithii Citratis EffervescSntis— Effervescent 
Lithium Citrate. — Dose, 1-2 drachms (4.0-8.0 Gm.). 

PREPARATIONS OF MAGNESIUM. 

Magnesia— Magrnesiae— Magnesia, JJ. 8,\P^ 

(Light Magnesia; Calcined Magnesia.) 

Orig-in. — Prepared by subjecting Magnesium Carbonate to a low 
red heat in a Cornish or Hessian crucible closed loosely by a lid. 

Description and Properties. — A white, very light, and very 
fine powder, without odor, and having an earthy, but not a saline, 
taste. On exposure to the air it slowly absorbs moisture and car- 
bon dioxide. Almost insoluble in water and insoluble in alcohol, 
but soluble in diluted acids. Magnesia should be kept in well- 
closed vessels. 

Dose. — As an antacid, 10-15 grains (0.6- LO Gm.). 

Official Preparation. 
Piilvis Rhei CompSsitus — Ptilveris Rhei Comp6siti — Compound Powder 
of Rhubarb. — Dose, as a laxative, 20-60 grains (1.30-4.0 Gm.). Formula: Rhubarb, 
25 ; Magnesia, 65 ; Ginger, 10 parts. 

Magnesii Carbonas— Magnesii Carbonatis— 
Magnesium Carbonate. TJ. S, I^. 

Origin. — Prepared by evaporating to dryness the mixed solu- 
tions of Magnesium Sulphate and Sodium Carbonate, and purifying 
and drying the residue. 

Description and Properties. — Light, white, friable masses, or 
a light, white powder, without odor, and having a slightly earthy 
taste ; permanent in the air. Almost insoluble in water, to which, 
however, it imparts a sHghtly alkaline reaction ; insoluble in alco- 
hol, but soluble in diluted acids, with active effervescence. 

Dose. — As an antacid, 5-20 grains (0.3-1.3 Gm.). 

PREPARATIONS OF AMMONIUM. 

Ammdnii Carbonas— Amm5nii Carbonatis— 
Ammonium Carbonate. TI, S, J*. 

Origin. — Prepared by a complicated process by heating in an 
iron or earthen retort a mixture of Sal Ammoniac and Chalk. 



ALKALIES. 159 

Description and Properties. — White, hard, translucent, striated 
masses, having a strongly ammoniacal odor without empyreuma, 
and a sharp, saline taste. On exposure to the air the salt loses 
both ammonia and carbonic acid, becoming opaque, and is finally 
converted into fi-iable porous lumps or a white powder. Slowly 
but completely soluble in about 5 parts of water at 15° C. (59° F.)^ 
and decomposed by hot water, with the evolution of carbonic acid 
and ammonia. By prolonged boiling with water the salt is com- 
pletely dissipated. The aqueous solution possesses a strongly 
alkaline reaction and effervesces with acids. 

Dose. — 3-10 grains (0.18-0.6 Gm.). 

Official Preparation. 

Spiritus Ammdnise AromSticus — Spiritus Ammoniae AromStici — Aromatic 
Spirit of Ammonia. — Composition: Ammonium Carbonate, Ammonia Water, Aro- 
matic Oil<^, Alcohol, and Water. 

Description and Properties. — A nearly colorless liquid when freshly prepared, 
but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor 
and taste. 

Dose. — i-l fluidrachm (1.8-3.7 Cc). 



Antagonists and Incompatibles. — The alkalies and their car- 
bonates are incompatible with acids and with metallic salts. The 
ammonium carbonate is incompatible with the acidulous salts and 
with lime water. 

Synergists. — Agents promoting waste, such as vegetable acids, 
mercury, iodine, etc., increase the therapeutic activity of the 
alkalies. 

Physiological Action. — The alkalies mentioned in this group 
may be divided into direct antacids, or those which neutralize or 
lessen the acidity of the stomach, and indirect antacids, or those 
which, being oxidized in the blood, are excreted as carbonates, 
diminishing the acidity of the urine and increasing the alkalinity of 
the blood, although not influencing the acidity in the stomach. 

The direct antacids are lime water, prepared chalk, and magnesia. 

The indirect antacids are potassium acetate, bitartrate, citrate, 
and tartrate, sodium acetate, and lithium citrate. 

The following alkalies are both direct and indirect antacids: 
solution of potassa, solution of soda, carbonates and bicarbonates 
of potassium, sodium, lithium, magnesium, and ammonium. 

The physiological action of the various alkalies will now be 
considered in detail. 



l6o A TEXT-BOOK OF MATERIA MEDICA. 

Externally a7td Locally. — The hydrates of potassium and sodium 
are caustic and rubefacient. The solutions of soda and potassa,. 
when applied undiluted, irritate the surface of the skin and soften 
and dissolve the epidermis and horny tissues, uniting with the 
albumin of the various structures to form a soluble alkali-albu- 
minate. The carbonates and bicarbonates exert a similar, though 
much weaker, action, while the acetates, bitartrates, citrates, and 
tartrates have no local influence. 

The ammonium salts do not affect the epidermis in the manner 
of those previously mentioned, penetrating without dissolving it,, 
irritating the underlying structures, and inducing an effusion of 
lymph, thus acting as vesicants. Should a strong solution of 
ammonia be applied to the skin and evaporation be prevented^ 
suppuration and sloughing may ensue. 

Internally. — Digestive System. — Potassium salts in small doses 
promote the secretion of gastric juice, thus obeying the law \yf 
which alkalies augment acid secretions. Large doses neutralize 
free acid in the stomach, and, by rendering the chyme neutral or 
alkaline, interfere with the secretion from the pancreas, liver, and 
intestines, thereby deranging digestion. 

Circulatory System. — The salts of potassium, by lessening the 
acidity of the gastric juice and entering the circulation, increase 
the alkalinity of the blood. The bicarbonates, however, taken in 
large doses upon an empty stomach, enter the circulation unchanged^ 
where, by decomposing the neutral phosphate of sodium present, 
they form the acid phosphate of sodium, reducing the alkalinitjr 
of the blood and increasing the acidity of the urine. 

Far different are the effects of these alkalies when taken after 
meals, the salts being then decomposed in the stomach by the 
acid gastric juice, the alkaline base increasing the alkalinity of the 
blood. 

The acetates, citrates, and bitartrates enter the blood unchanged. 
The acid radical being destroyed, and the base combining with the 
carbon dioxide formed, the salts are converted into the alkaline car- 
bonates, increasing the alkalinity of the blood and urine. It is 
believed that the amount of hemoglobin is increased by the potas- 
sium salts when the blood is deficient in this substance, though 
large doses interfere with the ozonizing function of the red blood- 
corpuscles. 

Should the caustic alkalies be injected directly into the blood,, 
death quickly ensues from coagulation of that fluid, arising from. 



ALKALIES. l6l 

excessive formation of alkali-albuminate. Under very large or 
poisonous doses the heart-muscle is weakened, decreasing the force 
of its contractions, arrest taking place in diastole. Even medicinal 
doses, if long continued, may occasion cardiac depression, diminish- 
ing the force of the circulation. Small doses may increase blood- 
pressure, though the pulse-rate be diminished. Brunton and Cash 
have demonstrated that minute amounts of potassium salts applied 
to muscle increase its contractile power, while large doses diminish 
or paralyze this force. 

Nervous System. — When potassium salts are administered in 
medicinal doses and for a reasonable length of time, no important 
action upon the nervous system is produced ; but if excessive doses 
be taken, the nerve-centers and motor nerves are paralyzed, after a 
period of temporary excitement. Owing, however, to the fact that 
potassium is a protoplasmic poison, affecting alike the muscles and 
nerve-tissues, its salts should not be given in full doses for too long 
a period without counteracting their depressing influence by the use 
of muscle- and nerve-tonics. 

Respiratory System. — The only action of importance upon the 
respiratory system is the increased amount and diminished viscidity 
of the secretion from the bronchial tubes. 

Absorption and Elimijiation. — The potassium salts possess very 
high diffusive power. They are easily and quickly absorbed and 
rapidly excreted, the salts with vegetable acids being eliminated 
as alkahne carbonates, rendering the urine alkaline. Salts of potas- 
sium are chiefly eliminated by the kidneys, though the process 
takes place to some extent through the bronchial mucous mem- 
brane and other secretions. They are active diuretics, increasing 
the amiount of water and, by stimulating the renal epithelium, 
augmenting the excretion of solids. The uric acid is greatly dimin- 
ished, being converted into urea, and as such eliminated, showing 
that the alkalies increase oxidation and promote waste. 

Temperature. — Medicinal doses have no effect upon temperature. 

Untoward Action. — Under prolonged dosage the digestion be- 
comes impaired. There is present paralysis of the muscular fibers 
of the intestines, accompanied by diarrhea or constipation and tym- 
panites. There may be also present emaciation, muscular weakness, 
nervous prostration, and anemia. 

Poisoning. — The caustic preparations of potassium produce all 
the symptoms of a corrosive mineral poison, somewhat resembling 
the poisonous action of the mineral acids already described. Death 
11 



1 62 A TEXT-BOOK OF MATERIA MEDIC A. 

is occasionally preceded by convulsions, the heart's action being 
arrested before respiratory failure. The carbonates and bicarbonates 
and the salts of vegetable acids are not considered poisonous, nor 
do they produce the corrosive effects of caustic potash or its solution. 

Treatment of Poisojiing. — Vegetable acids are chemically incom- 
patible, and should be given freely, together with oils and demul- 
cent drinks as protectives, and opium, if necessary, to reheve pain. 
Cardiac stimulants — digitalis, brandy, caffeine, etc. — may be required 
to sustain the heart, to be given hypodermically. 

The Comparative Action of the Alkalies. — Sodium salts in 
their action are analogous to potassium, although less irritating 
to the gastro-intestinal tract. They are also less depressing to 
the circulatory, muscular, and nervous systems. They differ from 
the potassium salts in that they lengthen, instead of shortening, 
the muscular curve. They are neither absorbed nor eliminated 
so rapidly, and are consequently less active as diuretics. They 
are not nearly so powerful solvents of uric acid, and are therefore 
inferior to the potassium salts in gout. Indeed, the nodules, known 
as " chalk-stones," frequently found upon the joints of gouty pa- 
tients are composed of urate of sodium. 

Lithium salts closely resemble in their effects those of potas- 
sium, their action upon the nerves and muscles, however, being 
less powerful. The contractile force of muscle is invariably di- 
minished by lithium and increased by potassium. As a solvent 
of uric acid, Hthium is the most powerful of all the alkalies, the 
urates, formed under the administration of the carbonate or citrate, 
being extremely soluble, rendering the alkaline salts of lithium 
superior to the other alkalies in gout and in the uric-acid diathesis. 

Calcium salts are more sedative and astringent in their action 
upon the gastro-intestinal tract than the other alkalies, and are 
direct antacids. They tend to produce constipation. The nervous 
and muscular systems are less affected by these salts than by the 
remaining alkalies, the contractile muscular force, however, being 
increased by calcium. They are less readily absorbed and excreted 
than the foregoing alkahes, and less active in increasing the alka- 
linity of the urine. 

Magnesium Salts. — Magnesia and the magnesium carbonates 
are direct antacids and sedative to the stomach, acting upon the 
intestinal canal as saline cathartics. In their influence upon the 
circulatory system they are feebler than, but similar to, the potas- 
sium salts, slightly increasing the alkalinity of the blood. They 



ALKALIES. 163 

are not so readily absorbed, nor so rapidly excreted, as the salts 
of potassium and sodium, while increasing the amount of water 
and solids excreted and acting as solvents of uric acid. 

Ammonium Salts. — These preparations are used rather as car- 
diac stimulants, their physiological action being more extensively 
considered under that group. As antacids their action may be 
briefly compared with that of the other alkalies. Their effect upon 
the gastric juice and its secretion is similar to that of the car- 
bonates and bicarbonates above mentioned. They dilate the blood- 
vessels of the stomach, augmenting the blood-supply and pro- 
ducing a sensation of warmth in the epigastrium. Lethal doses act 
as emetics. They increase the glycogenic function of the liver and 
stimulate the circulatory system, elevating the pulse-rate and rais- 
ing arterial tension. In medicinal doses they stimulate the spinal 
cord, motor nerves, and muscles, while toxic doses paralyze these 
structures. They prevent the coagulation of the blood and lessen 
the oxygen-carrying power of the red corpuscles. By them also 
the respirations are increased in frequency. 

The salts of ammonium are quickly absorbed and undergo oxi- 
dation in the body, augmenting the amount of uric acid and urea in 
the urine, thereby increasing its acidity to some extent. 

As regards the poisonous activity of the alkalies mentioned, 
ammonium ranks next to potassium, the most toxic of all. 

Therapeutics. — Extcr7ially and Locally. — Norton has recom- 
mended LIQUOR POTASSiE in mgrowing toe-7tail, the solution being 
appHed to the nail, which is soon rendered so soft that it can be easily 
scraped without causing pain. The same remedy is used in many 
diseases of the skin to allay itching and soften the horny epithelium. 
It is also employed extensively in diseases of the ear and throat, and 
in the proportion of i part to 10 of water it is very effective in 
softening impacted ceriunen. 

The POTASSIUM CARBONATE in solution is frequently used in various 
priiriginous diseases of the skin, being a highly efficient antipruritic. 

The detergent and sialagogue properties of potassium citrate 
and tartrate are rendered serviceable in c^rtddn diseases of the mouth. 

Sodium bicarbonate is a deservedly popular dressing for burns, 
and pain and swelling of the joints in acnte articidar rheumatism are 
sometimes greatly relieved by enveloping the articulations in a hot 
solution rendered alkahne with this salt. T. Michailoff highly 
recommends sodium bicarbonate in gramdar tonsillitis and pharyii- 
gitis, the powdered salt being applied every two or three hours. 



164 A TEXT-BOOK OF MATERIA MEDIC A, 

In diseases of the ear it is used for the same purposes as the potas- 
sium preparations above mentioned. It is one of the ingredients 
of *' Dobell's Solution," which is an effective antiseptic wash in 
nasal eatarrh, and the solution of sodium bicarbonate has been sug- 
gested by Forchheimer as a valuable remedy in thrush or aphthce. 

Sodium carbonate may be used for the same purposes as the 
bicarbonate, though probably inferior to it in all cases save infantile 
eczema capitis, in which condition it is a most valuable remedy for 
softening the eczematous crusts. 

Prepared chalk is an ingredient of many ointments used in the 
treatment of erysipelas and subacute eczema. Lime water, mixed 
with equal parts of linseed or olive oil, is highly prized as a dress- 
ing for burns, and the efficiency of the *' black " and " yellow " 
washes in the treatment of venereal sores is too well known to 
require further testimony in their favor. These latter preparations 
also make excellent applications in acute eczema. Lime water may 
sometimes be used with advantage in leucorrhea and vaginitis. 

LiTHii cARBONAS, in the proportion of 5 grains (0,3 Gm.) to 
I ounce (30.0 Cc.) of water, is highly recommended by Garrod 
for the removal of gouty deposits, the solution being kept con- 
stantly applied to the parts by means of lint or absorbent cotton. 

Magnesium carbonate makes an efficient dusting powder in der- 
matitis and irritable conditions of the skin. Ammonium carbonate 
mixed with lanolin readily dissolves the epidermic scales of psori- 
asis, and the aromatic spirit of ammonia is a grateful application 
to the scalp in pityriasis. 

Internally. — Digestive System. — The carbonates and bicarbon- 
ates, when given before meals, serve to increase the flow of gastric 
juice. They act as sedatives to the stomach, particularly in painfid 
conditions arising from a deficient secretion of gastric juice. As 
antacids, when given after meals, they are very useful in counter- 
acting excessive acidity of the stomach. The acidity due to the 
formation of fatty acids, the result of defective digestion, is not 
relieved by the administration of these salts after meals, but if 
taken before meals they are valuable in correcting the deficiency 
of gastric secretion to which the disordered digestion is due. In 
atonic dyspepsia these preparations administered with vegetable 
bitters serve a useful purpose. 

The bicarbonates and the salts of the vegetable acids, by increas- 
ing the alkalinity of the blood, are of great value in gout, the lithia 
salts being the most efficient in this condition. They are also of 



ALKALIES. 165 

great benefit in the treatment of acute rJieiimatism. The extensive 
experience of the author in connection with the latter disease justifies 
the statement that in the treatment of them alkaHes are far superior 
to any other drugs, salicylic acid not excepted. It is necessary to 
saturate the system with some bland alkali, preferably a sodium 
salt, that the pernicious effects of the increased amount of uric acid 
formed may be rendered nugatory until convalescence shall have 
become assured. Thorough alkalinization should be produced and 
maintained, so that the sweat, saliva, and urine, which are acid in 
acute rheumatism, shall give no acid reaction to blue litmus-paper. 

While it is admitted that the treatment of acute rheumatism by 
alkalies alone will not shorten the course of the disease so readily 
as the employment of salicylates, there is certainly less danger of 
heart-complications, the period of convalescence is reduced, and 
the tendency to relapse lessened by the use of alkaline remedies. 

Even in chronic rheumatism where no serious renal derange- 
ments exist the mild alkalies, which are well borne by the stomach, 
are undoubtedly indicated, since it is well known that in chronically 
rheumatic subjects there is a decidedly lessened alkalinity of the 
blood. It is, perhaps, unnecessary to add that in the treatment of 
these cases proper hygiene, food, and cholagogues are important 
adjuncts to successful management The author is disposed to go 
still further and urgently recommend complete alkalinization of the 
system, in connection with other therapeutic measures, in deaHng 
with rlieumatoid arthritis. 

The acetates, bitartrates, and citrates are efficient diuretics, 
cathartics, and diaphoretics, the first-named salts being superior 
diuretics, the potassium bitartrate a reliable cathartic, and the 
citrates active diaphoretics. 

In lithemia these salts serve a valuable purpose by rendering 
the urine persistently alkaline, retarding the formation of uric-acid 
calcidi, and even dissolving small calculi of this variety. 

In chronic Bright' s disease the acetates and citrates are fre- 
quently indicated for their diuretic action, while potassium bi- 
tartrate is one of the most effective cathartics and diuretics in 
acute nephritis and cardiac dropsy. 

Lime water is a useful remedy for vomiting — whether due to 
irritability, gastric ulcer, or cancer — and is also valuable in check- 
ing this symptom in pulmonary tubercidosis. It is an important 
adjunct to milk, in preventing the formation of curds and relieving 
infantile 



l66 A TEXT-BOOK OF MATERIA MEDICA. 

In the acute mycotic diarrhea of children, characterized by acid 
gastro-intestinal fermentation, the above combination is extremely 
useful. The symptoms also of chronic diarrhea and dysentery are 
often mitigated by this simple remedy. In rachitis and osteomalacia 
it has in certain cases appeared to be beneficial. 

Lime water is without doubt a very efficient remedy in diabetes 
insipidus, and may also exert a favorable influence in chrofuc bron- 
chitis by checking and otherwise modifying the mucous secretion. 
It should be remembered that this preparation is a valuable anti- 
dote in arsenical poisoning. The syrup of lime is a very inferior 
remedy, the sugar which it contains neutralizing the beneficial 
action which the lime alone might exert. 

Prepared chalk, or chalk mixture, is useful in relieving the 
premonitory diarrhea of cholera, and simple diarrheas of children, 
with greenish acid stools and flatulent distention of the abdo- 
men, are greatly benefited by this preparation. It is very neces- 
sary, however, that the chalk mixture be freshly prepared, the 
cinnamon water it contains being liable with age to fungoid con- 
tamination, and the propagation of microorganisms, which would 
seriously aggravate the condition for which the remedy is given, 
occasioning vomiting, etc. 

Magnesia is an invaluable antacid in gastric disorders, and 
especially in aphthce attending infantile diarrhea. 

As above stated, the lithium preparations are unquestionably 
superior to the other alkalies in the gouty and uric-acid diatheses. 

The ammonium preparations are useful antacids, being particu- 
larly efficacious in the dyspepsia of drunkards to allay nausea and 
vomiting, render the mucus less viscid, and act as stimulants to 
the circulation. Their excitant qualities, together with their prop- 
erty of modifying the mucous secretion, render them^ also of value 
in appropriate cases of subacute and chronic bronchitis. The re- 
maining important uses of the ammonium preparations will be 
considered under " Cardiac Stimulants." 

In conclusion, it may be well to mention the value of alkalies 
in aiding the digestion of fats, and as efficient remedies in the dys- 
pepsia and indigestion from which obese, gouty, and rheumatic 
subjects frequently suffer. 

The virtue and uses of mineral waters will be fully discussed in 
the following group devoted to the subject. 

Contraindications. — Alkalies are contraindicated in the phos- 
phatic diathesis, since there is danger of the formation of phosphatic 



MINERAL WATERS. 167 

calculi. The calcium preparations should not be given to patients 
suffering from oxaluria. 

Administration, — The alkalies should invariably be adminis- 
tered largely diluted, thus favoring absorption and preventing their 
irritant action upon the gastro-intestinal mucous membrane. The 
time of administration — whether before or after meals — will depend 
entirely upon the effect desired, a thorough knowledge of their 
action as above given being necessary to an intelligent and proper 
use of the various preparations. 



GROUP VI.— MINERAL WATERS. 

The line of demarcation between mineral and ordinary waters 
cannot be definitely drawn. Although in the former there is usu- 
ally present an excess of mineral constituents or of temperature, 
some drinking waters contain more mineral ingredients than others, 
while many very pure waters, both cold and warm, have been re- 
garded for ages as mineral springs. As Pliny. observed, waters are 
such as the soil through which they flow, it being a matter of 
observation that chalk or limestone formations, for instance, natu- 
rally impregnate with their normal constituents the springs originat- 
ing in them. Still, it is impossible to determine with certainty the 
depth from which these waters flow, or to ascertain the various dis- 
tances from the surface at which they assimilate foreign ingredients. 

Nor are the geographical distribution and altitude of mineral 
springs less remarkable than the diversity of their constituents. 
Although especially abundant in volcanic regions, mineral springs 
are by no means confined to them. They have been found on 
alpine heights — even at the snow-line in the Himalayas — and they 
rise from the bottom of the sea, as at Baise and Ischia. 

The foreign ingredients of mineral waters, as shown by analysis, 
are very numerous, some of them occurring in exceedingly minute, 
others in large, quantities. Among them are soda, magnesium, 
calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, 
lithium, cesium, rubidium, fluorine, barium, copper, zinc, manga- 
nese, strontium, silica, phosphorus, besides extractive substances 
and various organic deposits known under various names. The 
constituent gases include carbonic and hydrosulphuric acids, nitro- 
gen, oxygen, hydrogen, and ammonia. Of all these, by far the 



1 68 A TEXT-BOOK OF MATERIA MEDIC A. 

most important from a therapeutic point of view are sodium, mag- 
nesium, iron, carbonic acid, sulphur, and perhaps hydrosulphuric 
acid. The various substances detected separately by chemists are 
in their analyses combined by them into various salts — if not with 
absolute certainty, undoubtedly with a close approximation to it. 

These combinations are very numerous, some waters containing 
from lo to 20 per cent, of them; yet there are always certain pre- 
dominating constituents which mark the character of the spring, 
while many substances, such as cesium, rubidium, or fluorine, occur 
in mere traces and must be regarded as unimportant. 

Mineral waters may be considered, therefore, as weaker or 
stronger solutions of salts and gases of higher or lower tempera- 
ture, although the quantity of saline ingredients commonly bears 
but a very small proportion to that of the fluids containing them. 
For purposes of therapy they are used either externally in the form 
of baths or internally as beverages. With regard to the former 
use — or, to speak technically, balneotherapy — the scope of the 
present work precludes treatment /;/ extenso. Enough to say that 
in certain conditions the system is undoubtedly benefited by resort 
to baths of various characters, especially when accompanied by the 
accessory aid of well-considered diet and regimen. 

The literature connected with the subject of potable waters is 
voluminous, yet the deductions drawn by various observers touch- 
ing their efficacy and in relation to the comparative value of natural 
springs are too frequently colored by individual bias, or based upon 
too hasty analysis to furnish infallible data or warrant the definite 
statement possible in ordinary therapeutics. That certain waters 
charged with foreign ingredients when ingested react upon the 
system favorably in the case of certain disorders it were futile to 
deny. Yet even here there are subsidiary considerations not to be 
ignored ; and it is an open question how far the patient may be 
relieved by the potency of the remedy per se, or whether the col- 
lateral aids of environment, cHmate, altitude, temperature, etc. may 
not have an important bearing upon beneficial results. 

It has been well observed that in the case of water taken in situ 
the curative atmosphere of the surroundings, the favorable season 
of the year, the reflex influence of social amenities, and freedom 
from customary cares, aided by studied regimen under constant 
medical supervision, play no unimportant part in the alleviation of 
positive or imaginary disorders. The maxim, "Amuse the patient 
and let nature work the cure," seems not wholly inapplicable to 



MINERAL WATERS. 169 

many fashionable resorts where a constant round of gayety acts as 
a practical, though imperceptible, tonic or stimulant upon subjects 
of certain nervous susceptibilities. These considerations are no 
less forcible in the case of American " watering-places " than in 
those of the more famous resorts of Europe. 

Various attempts have been made to range mineral waters 
according to their therapeutic action, their external and internal 
effects physiologically, and, most frequently, according to their 
chemical composition. Yet their influence is so dependent upon 
idiosyncrasy and their constituents so varied that it is wellnigh 
impossible to select a definite system free from objections, although 
a scientific classification, uniformly adopted, would undoubtedly 
promote their rational employment. Many sulphur waters are 
practically earthy or saline ones, yet the presence of minute quan- 
tities of hydrosulphuric acid, an ingredient so palpable as always 
to attract attention, has determined a classification obviously at 
variance with natural fact. The general rule has been to class 
waters under the head of their predominating elements, the desid- 
eratum being comparative simplicity untrammelled by theoretical 
considerations. In this view perhaps the most convenient arrange- 
ment of native mineral springs is that subjoined, adopted by Dr. 
A. N. Bell and widely accepted by writers on therapeutics : 

Alkaline. — These waters owe their chief therapeutic value to 
the alkaline salts they contain. They are rich in alkaline car- 
bonates, especially the sodium carbonate. Other substances are 
included among their ingredients, many of them strongly charged 
with carbonic-acid gas, which may possibly contribute to their 
physiological activity. 

Saline. — These either contain (i) chloride of sodium as the 
principal ingredient, or (2) are largely impregnated with the sul- 
phates of sodium and magnesium. Several other ingredients enter 
into their composition, yet their efficacy chiefly depends upon their 
predominating elements : the second class includes the bitter or 
purgative waters highly prized both in this country and abroad. 

Sulphuretted. — The sulphuretted hydrogen present in these 
waters lends to them their chief therapeutic value. They contain 
also various sulphides — of potassium, sodium, calcium, and mag- 
nesium — together with earthy and other sulphates, which doubtless 
contribute in a measure to their potency as physiological agents, 
although their action upon the system is still a matter of con- 
jecture. 



170 



A TEXT- BOOK OF MATERIA MEDIC A. 



Chalybeate. — Many mineral springs contain iron, yet in 
amounts so insignificant as to be of little value to therapy. There 
are, however, chalybeate waters highly charged with iron salts in 
the form of the carbonate or sulphate which have acquired a repu- 
tation for efficacy in the treatment of certain diseases. 

Acidulous. — The valuable property of these springs Kes in the 
superabundance of carbonic-acid gas they contain, to which the 
solid constituents are subordinate, the carbon dioxide being the 
important therapeutic ingredient. 

Calcareous. — Calcium, in the form of the carbonate, is the 
valuable constituent of calcareous waters. Besides this substance 
they contain magnesium carbonate in varying quantities. Their 
utility as mineral waters has been questioned, many authorities 
refusing them recognition as therapeutic agents. 



The following enumeration 
able Hst compiled by Dr. A. N 

Alkaline : 

Adams, California. 
Albury, Vermont. 
Alum, Virginia. 
Borax, California. 
Blount, Alabama. 
Berkshire, Vermont. 
Caiion City, Colorado. 
Carlisle, Colorado. 
Congress, California. 
Elgin, Vermont. 
Fry's Soda, California. 
Highland, California. 
Highgate, Vermont. 
Lower Soda, California. 
Milford, New Hampshire. 
Manitou, Colorado. 
Middletown, Vermont. 
Napa Soda, California. 
Newbury, Vermont. 
Perry, Illinois. 
Rocky Mountain, Colorado. 
Ravenden, Arkansas. 
South Park, Colorado. 



of native springs is from the admir- 
. Bell : 

Summit Soda, California. 
Seltzer, California. 
Sheldon, Vermont. 
Vichy, California. 
Wilholt Soda, California. 

Calcic : 

Bethesda, Wisconsin. 
Butterworth, Michigan. 
Birch-Dale, Vermont. 
Clarendon, Vermont. 
Eaton Rapid, Michigan. 
Gettysburg, Pennsylvania. 
Hubbardstown, Michigan. 
Silurian, Wisconsin. 

Chalybeate : 
Abbeville, South Carolina. 
Bedford, Pennsylvania. 
Blossburg, Pennsylvania. 
Cooper's Well, Mississippi. 
Esbitt, Kentucky. 
Fayette, Pennsylvania. 
Gordon's, Georgia. 



MINERAL WATERS. 



171 



Greencastle, Indiana. 
Kittrell's, North Carolina. 
Madison, Georgia. 
Manley, North Carolina. 
Milford, New Hampshire. 
Montvale, Tennessee. 
Owasso, Michigan. 
Rowland's, Georgia. 
Schooley's Mountain, New 

Jersey. 
Schuyler County, Illinois. 
Sparta, Wisconsin. 
Versailles, Indiana. 

Ptirgativc Saline : 

Blue Lick, Kentucky. 
Crab Orchard, Kentucky. 
Elgin, Vermont. 
Esculapian, Kentucky. 
Harrodsburg, Kentucky. 
Midland, Michigan. 
Pagosa, Colorado. 

Saline : 

Fruit-Port Well, Michigan. 
Grand Haven, Michigan. 
Louisville Artesian, Kentucky. 
Michigan Congress, Michigan. 
Mt. Clemens, Michigan. 
Ocean, Alabama. 
Salt, Virginia. 

Spring Lake Well, Michigan. 
St. Louis, Missouri. 

Sulphurous : 

Alpena, Michigan. 
Balston, New York. 
Bladon, Florida. 
Blue Lick, Kentucky. 
Carlisle, Pennsylvania. 
De Soto, Louisiana. 



Dremion, Kentucky. 
French Lick, Indiana. 
Glenn's, South Carolina. 
Highgate, Vermont 
Indian, Georgia. 
Indian, Indiana. 
Lodi Artesian, Indiana. 
Manley, North Carolina. 
Minnequa, Pennsylvania. 
Montesano, Missouri. 
Olympian, Kentucky. 
Portea Springs, Colorado. 
Salt Sulphur, Virginia. 
Saratoga, New York. 
Sharon, New York. 
Sheldon, Vermont. 
Shocco, North Carolina. 
St. Helena White Sulphur, 

California. 
St. Louis, Michigan. 
Sweet, Missouri. 
Valhemosa, Alabama. 
West Baden, Indiana. 
White Sulphur, Louisiana. 
White Sulphur, Montana. 
White Sulphur, Virginia. 

Unclassified : 
Alum, Virginia. 
Birch-Dale, New Hampshire. 
Borax, California. 
Climax, Missouri. 
Eureka, Arkansas. 
Fairview, Texas. 
Greeneleone, Florida. 
Geysers, the American, Wyo- 
ming. 
Geyser Spa, California. 
Iodide and Bromide, Missouri. 
Piedmont, Texas. 
Stafford, Connecticut. 



172 



A TEXT-BOOK OF MA TERIA MEDICA. 



Summit, Maine. 
Sheldon, Vermont. 

Thermal Springs: 
Agua Caliente, New Mexico. 
Arrow-Head, California. 
Buncombe County, North 

Carolina. 
Calistoga, California. 
Chalk Creek Hot, Colorado. 
Charleston Artesian, South 

Carolina. 
Des Cahutes Hot, Oregon. 



Harbines, California. 
Hot Springs, Arkansas. 
Idaho Hot, Colorado. 
Merriweather, Georgia. 
Middle Park Hot, Colorado. 
Ojo CaHente, New Mexico. 
Paraiso, California. 
Passo Robles, California. 
Salt Lake, Utah. 
Seigler, California. 
Skaggs, California. 
Volcano, Nebraska. 
Warm and Hot, West Virginia. 



GROUP VII.— BITTERS. 

SIMPLE BITTERS. 

Quassia— Quassiae— Quassia. 77. S, JP. 

Orig-in. — The wood of Picrcena excelsa Swz., a tree resembling 
the common ash, attaining a height of from 60 to 80 feet (18-24 
M.), indigenous in Jamaica. 

Description and Properties. — In the shops it is usually met 
with in the form of chips or raspings of a yellowish-white color. 
Quassia contains two bitter principles — quassin and picrasmin. It 
contains no tannin. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extractum Quassiae — Extr^cti Quassiae — Extract of Quassia. — Dose, 1-3 
grains (0.065-0.2 Gm.). 

Extractum Quassiae Fluidum — ExtrScti QuSssiae Fluidi — Fluid Extract 
of Quassia. — Dose, 10-30 minims (0.6-2.0 Cc). 

Tinctura Quassiae — Tincturae Quassias — Tincture of Quassia. — Dose, \-2 
fluidrachms (2.0-7.3 Cc). 

Gentiana—Gentianae— Gentian. 77. H. JP. 

Origin. — The root of Gentiana lute a L., a plant from 2 to 3 feet 
high, indigenous in the mountainous portions of Central Europe. 

Description and Properties. — It appears in nearly cylindrical 
pieces or longitudinal slices about i inch (25 Mm.) thick, the upper 
portion closely annulate, the lower longitudinally wrinkled ; exter- 
nally deep yellowish-brown ; internally lighter ; somewhat flexible 



BITTERS. 173 

and rather thick, separated from the subspongiose meditullium by 
a black cambium Hne. Odor pecuHar, faint, stronger when moist- 
ened ; taste sweetish and persistently bitter. Gentian contains a 
bitter principle, gciitiopicrin, and also gcntisic acid, to which its 
yellow color is due. It contains about 15 per cent, of glucose, but 
no starcJi or tannin. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Extractum Gentianae— Extract! Gentianae— Extract of Gentian.— Z>oj^, 2- 
10 grains (0.12-0.6 Gm.). 

Extractum Gentianae Fluidum— ExtrScti Gentianae Fluidi— Fluid Extract 
of Gentian. — Dose, 5-30 minims (0.3-2.0 Cc). 

Tinctura Gentianae CompSsita— Tincturae Gentianae Comp6sitae— Com- 
pound Tincture of Gentian.— Z^ojf, 1-2 fluidrachms (4.0-8.0 Cc). 10 per cent, 
with Orange Feel and Cardamom. 

Calumba-Calumbae— Calumba. Z, S. P. 

(COLUMBO.) 

Origin. — The root oi Jatcorhiza pahnata, Lam., a plant native 
to the forests of Eastern Africa and Madagascar, and cultivated 
in the East Indies. 

Description and Properties. — Nearly circular disks i to 2 
inches (25-50 Mm.) in diameter and ^ to ^ inch (6-12 Mm.) thick. 
Externally greenish-brown and wrinkled ; internally yellowish or 
grayish-yellow ; depressed in the center, with a few^ interrupted cir- 
cles of projecting wood-bundles ; distinctly radiate in the outer por- 
tion; fracture short, mealy; odor slight; taste mucilaginous, slightly 
aromatic, v^ry bitter. It contains a bitter crj^stalline principle, ca- 
lumbiii, cahunbic acid, bcrberine, and starch. Xo tannin is present. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 

Official Preparations. 

Extractum Caltimbae Fliiidum— ExtrScti Caltimbae Fluidi— Fluid Extract 
of Calumba. — Dose, io-<:>o minims (0.6-4.0 Cc). 

Tinctiira Caltimbae — Tincturae Caltimbae — Tincture of Calumba. — Dose, i- 
4 fluidrachms ('4.0-15. Cc). 

Calendula— Calendulae— Calendula. 77. >S^. IP. 

('Marigold.) 

Origin. — The florets of Calendida officinalis L., an annual plant, 
a native of the Levant and Europe, frequently cultivated as a 
garden ornament. 



174 ^ TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — Florets about \ inch (12 Mm.) 
long, linear and strap-shaped, delicately veined longitudinally, 
yellow or orange-colored, three-toothed at the apex, the short, 
hairy tube enclosing the remnants of a filiform style elongately 
cleft. Odor sHght and somewhat heavy ; taste rather bitter and 
faintly saline. It contains a peculiar gummy principle, calendulin, 
a bitter constituent, and a trace of volatile oil. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Pj'eparation. 

Tinctura Calfendulae — Tincturae CalSndulse— Tincture of Calendula. — Dose, 
15-60 minims (1.0-4.0 Cc). 

Unofficial Preparation. 

Extractum Calgndulae Fluidurn— ExtrScti CalSndulae Fluidi — Fluid Ex- 
tract of Calendula. — Dose, 5-30 minims (0.3-2.0 Co.). 

Chirata— Chiratae— Chirata. 77. 8. JP. 

Origin. — The entire plant, Swertia chirata Hamilton, an annual, 
native to Northern India. 

Description and Properties. — Chirata as found in the shops 
consists of short sections of the stem and branches pressed and 
split, brown or dark-purple in color, and mixed with a few leaves 
and flowers. It contains a very bitter yellow principle, a hygro- 
scopic powder, chiratin, a bitter syrupy Hquid, ophelic acid, a resin, 
coloring matter, etc. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Official Preparations. 

ExtrSctum Chiratae Fluidum — ExtrScti Chiratae Fliiidi — Fluid Extract of 
Chirata. — Dose, 5-20 minims (0.3-1.3 Cc). 

Tinctura Chiratae — Tincturae Chiratae — Tincture of Chirata. — Dose, j4.-i 
fluidrachm (2.0-4.0 Cc). 

AROMATIC BITTERS. 

Anthemis— Anthemidis— Anthemis. TJ, S. P. 

(Chamomile. ) 

Origin. — The flower-heads oi Anthemis nobilis L., a low peren- 
nial plant indigenous in Southern and Western Europe. 

Description and Properties. — Heads subglobular, about |- inch 
(2 Cm.) broad, consisting of an imbricated involucre and numerous 
white, strap-shaped, three-toothed florets, and a few, if any, yellow 



BITTERS. 175 

tubular disk-florets, inserted upon a chaffy, conical, solid receptacle ; 
of a strong, agreeable odor and an aromatic, bitter taste. Anthemis, 
contains a bitter principle, a pale-blue or yellowish-brown volatile 
oil, and a trace of tannin, together with other unimportant con- 
stituents. 

Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion or fluid extract, 

Cascarilla— CascarTIlae— Cascarilla. 17. S, JP, 

Origin. — The bark of Croton chitcria, Bennett, a small shrub 
indigenous in the Bahama Islands. 

Description and Properties. — Quills or curved pieces about -^ 
inch (2 Mm.) thick, having a grayish, somewhat fissured, easily 
detached, corky layer, more or less coated with a white lichen, the 
uncoated surface being dull brown, the inner surface being smooth. 
The bark breaks with a short fracture, having a resinous and 
radially striate appearance. When burned it emits a strong, aro- 
matic, somewhat musk-like odor ; taste warm and very bitter. It 
contains a volatile oil, a bitter, crystalline principle, cascarillhi, tannin, 
resin, etc. 

Dose. — 10-30 grains (0.6-2.0 Gm.), or 10-30 minims (0.6-2.0 
Cc.) of the fluid extract. 

Prunus Virginiana— Pruni Virginianae— Wild 
Cherry. V. S. I*. 

Origin. — The bark, collected in autumn, of Pinmus serotina 
Ehr, a large forest tree indigenous in North America. 

Description and Properties. — It is met with in curved pieces 
or irregular fragments -^ inch (2 Mm.) or more thick; outer 
surface greenish-brown or yellowish-brown, smooth and somewhat 
glossy, marked with transverse scars. If the bark is collected from 
the old wood and deprived of the corky layer, the outer surface is 
nut-brown and uneven ; inner surface somewhat striate or fissured. 
Upon maceration in water it develops a distinct bitter-almond odor. 
Taste astringent, aromatic, and bitter. It contains a volatile oil, 
hydrocya^iic acid, tannin, a bitter glucoside, resin, etc. 

Dose. — \-\ drachm (2.0-4.0 Gm.). 

Official Preparations. 

Extractum Pruni Virginianae Fluidum — Extr^cti Pruni Virginianse Fluidi 
— Fluid Extract of Wild Cherry. — Dose, 30-60 minims (2.0-4.0 Cc). 



176 A TEXT-BOOK OF MATERIA MEDICA. 

Infusum Pruni Virginianse — Infusi Pruni Virginianae — Infusion of Wild 
Cherry. — Dose, 1-2 fluidounces (30.0-60.0 Cc). 

Syrupus Pruni Virginianae — Syrupi Pruni Virginianse — Syrup of Wild 
Cherry. — Dose, 2-4 fluidrachms (8.0-15. Cc). 

Serpentaria— Serpentariae— Serpentaria. 77. >S^. J^. 

(Virginia Snake-root.) 

Origin. — The rhizome and roots of Aristolochia serpentaria L., 
and of Aristolochia retictdata Nutt., perennial herbs indigenous in 
the United States. 

Description and Properties. — The rhizome is about i inch (25 
Mm.) long, thin, curved ; on the upper side with approximate^ 
short stem-bases ; on the lower side with numerous thin, branching 
roots about 4 inches (10 Cm.) long; dull yellowish-brown, inter- 
nally whitish ; the wood-rays of the rhizome are longest on the 
lower side; odor aromatic, camphoraceous ; taste warm, bitterish^ 
and camphoraceous. It contains \ per cent, of volatile oil, a bitterish 
principle, aidstolochine , tannin, resin, starch, etc. The roots of 
Aristolochia reticulata are coarser, longer, and less interlaced than 
those of Aristolochia serpentaria. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

. Official Preparations. 

Extractum Serpentariae Fluidum — ExtrScti Serpentariae Fliiidi — Fluid 
Extract of Serpentaria. — Dose, 10-30 minims (0.6-2.0 Cc). 

Tinctura Cinchdnae Composita — Tincturae Cinchonae CompSsitae — Com- 
pound Tincture of Cinchona. — Dose, 1-4 fluidrachms (4.0-15. Cc.) (2 per cent, 
of serpentaria.) 

Tinctiira Serpentariae — Tinctiirae Serpentariae — Tincture of Serpentaria. — 
Dose, i-2 fluidrachms (2.0-8.0 Cc). 



Antag-onists and Incompatibles. — The salts of iron, lead, and 
silver are incompatible with gentian and the aromatic bitters, though 
preparations of iron can be given with quassia and calumba. Boil- 
ing water impairs the virtues of wild cherry. 

Synergists. — The digestants, mineral acids, and, under certain 
conditions, alkalies, and the restorative agents generally, aid the 
action of vegetable bitters. 

Physiological Action. — Because of their action in augmenting 
the secretions from the salivary and gastric glands, aiding diges- 
tion and improving nutrition, Vegetable Bitters are classed among 
Restoratives. By increasing the activity of the various glands they^ 



BITTERS. 



177 



aid digestion, and by their effect upon the nerves they stimulate the 
appetite. 

Pure bitters act immediately upon contact ; that is, their 
efficiency is due to their local action upon the mucous membrane 
of the gastro-intestinal tract, with which they are brought into 
direct contact. There are certain drugs, however — such as cin- 
chona, nux vomica, etc. — which act also upon the blood or remote 
parts of the system. When used as bitters we are concerned only 
with the local action of these agents. 

I. Bitters increase the secretion from the salivary glands. This 
effect is produced by stimulating the ends of the nerves of taste 
distributed in the mucous membrane of 

the mouth, from which nerves the im- 
pression is conveyed to the center in the 
medulla, and from there transmitted to 
the vaso-motor and secretory nerves sup- 
plying the salivary glands, increasing their 
blood-supply and activity, and at once 
promoting the secretion of saliva. Were 
salivary secretion stimulated by the drug 
entering the circulation, and through the 
blood exciting the medulla and the glands, 
a much longer time would elapse before 
an increased flow of saliva would be pro- 
duced. It is therefore certain that the 
rapid reflex excitation of the glands, and 
consequent immediate increase in the sal- 
ivary secretion, are due to direct contact 
with the nerve-endings in the mucous 
membrane of the mouth. The accompanying diagram (Fig. i) 
will serve to elucidate the action named. 

II. Bitters increase the secretion from the gastric glands. The 
primary action is an augmented flow of gastric juice, caused by 
reflex stimulation from the mouth. It is well known that there 
is an intimate relationship between the stomach and the senses of 
taste and smell — the taste of victuals or the odor of a tempting 
dinner, or the familiar instance of a dog looking wistfully at a meat- 
stand, exciting the appetite and, reflexly, the flow of gastric juice. 
Bitters act in a similar manner. The nerves of taste are stimu- 
lated ; the impression is conveyed to the medulla, and from it trans- 




FiG. I. — Diagram illustrating the 
action of bitters on the salivary 
glands: i, nerve conveying the 
impression from the mucous mem- 
brane of the mouth (C) to the me- 
dulla {A) ; 2, secretory nerve trans- 
mitting the impression from the 
medulla {A) to the salivary gland 
{B) ; 3, duct of the salivary gland. 



mitted not only to the salivary 
12 



;lands, but through the fibers of 



178 



A TEXT-BOOK OF MA TERIA MEDICA. 




the vagus, increasing the blood-supply to the gastric glands and 
thereby promoting their functional activity. 

When the bitters have been swallowed, an increased secretion 
ensues, occasioned by direct stimulation of the mucous mem- 
brane of the stomach. Through the sen- 
sory fibers of the vagus the impression is 
conveyed to the center in the medulla, 
returning by the vaso-motor and secretory 
fibers, and increasing the functional activity 
of the glands. This action is well shown 
in the diagram (Fig. 2). 

When too large a dose of bitters has 
been taken, or under prolonged medicinal 
dosage — when contraindicated by an irri- 
table stomach — the effects are a diminished 
secretion of gastric juice and a corre- 
sponding increase in the secretion of mucus. 
This effect of over-stimulation or irritation 
is well illustrated in persons addicted to the 
excessive use of alcohol, a moderate amount 
promoting the secretion of gastric juice and 
im.proving the appetite, while excess occa- 
sions nausea and the vomiting of glairy 
mucus. 

The theory governing the above action 
is that a medicinal dose of bitters is just 
sufficient to stimulate the functional activity 
of the gastric glands, but that immoderate 
or continuous dosage tends to convey the impression farther up in 
the medulla, causing stimulation of the vaso-constrictor fibers, con- 
tracting the blood-vessels, and lessening the blood-supply and the 
secretion from the glands. At the same time the secretory fibers 
supplying the mucous cells are stimulated, causing an increased 
secretion of mucus. Should the dose be sufficiently large to pro- 
duce vomiting, the action is due to the fact that the impression is 
conveyed still higher in the medulla, and from there transmitted 
to the nerves supplying the abdominal walls and diaphragm, the 
effect being to produce emesis. The diagram (Fig. 3) graphically 
illustrates this action. 

III. Bitters stimulate the peristaltic movements of the stomach 
by reflex action. The sensory nerves in the mucous membrane are 



Fig. 2. — Diagram illustrating 
the action of bitters on the gas- 
tric secretion: A, medulla; B, 
stomach ; C, gland ; D,D, blood- 
vessels supplying the gland; E, 
nerves of taste ; i, vaso-motor 
fibers ; 2, secretory fibers ; 3, sen- 
sory fibers. 



BITTERS. 



179 



irritated, and an impression is conveyed by them to Auerbach's 
plexus between the muscles in the walls of the stomach, from 
which plexus, or ganghon, the influence is transmitted to the mus- 
cles themselves, causing increased activity or peristalsis. 

Another method by which peristalsis is stimulated occurs when 
the impression is conveyed by the sensory nerves directly to the 
center in the medulla, and from there through the motor fibers of 
the vagus to Auerbach's plexus, affecting the muscles in the man- 
ner above described. The cut (Fig. 4) will serve to illustrate the 
modus operandi. 




Fig 3. — Diagram illustrating the supposed nervous connections of the stomach. A gentle stimulus 
applied to the walls of the stomach is transmitted by the afferent nerves {A) to a nerve-center (5), 
and thence along the vaso-dilating nerves (C) and the secreting nerves {U) to the vessels of the mucous 
membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve- 
center {E), and thence along the vaso-constricting libers {F) and the secreting fibers (G) of the mu- 
cous follicles. A still stronger stimulus is transmitted to H, and thence along the motor nerves to the 
abdominal walls {K, K), causing them to contract and produce retching or vomiting. 



IV. Bitters augment absorption by increasing the blood-supply 
to the mucous membrane of the stomach. It is a physiological 
fact that the larger the blood-supply passing through the blood- 
vessels, and the greater the amount of lymph conveyed through 
the lymph-channels, the more rapid the absorption. 

V. Bitters are more or less antiseptic and arrest fermentation, 
both physiological and pathological. The peptonization of food is 



i8o 



A TEXT-BOOK OF MATERIA MEDIC A. 



a physiological fermentative process, forming a contraindication to 
the administration of bitters during active digestion. 

Therapeutics. — Externally and Locally. — Calendula, in the 
form of a poultice, is an efficient and grateful application as a dress- 
ing to cancer of the breast. The tincture 
of calendula is recommended by many phy- 
sicians as an external application for contu- 
sions, sprains, etc., although not so efficient 
as tincture of arnica. The drug has been 
used topically in chronic pharyngitis and 
suppurative i7iflannnation of the ear. 

Internally. — The simple bitters are pecu- 
liarly useful in atonic and fermentative dys- 
pepsia, chronic gastric catarrh, and as a tonic 
in convalescence from acute disease, in mala- 
rial fever, and in the anorexia following it. 
Infusion of quassia is a most efficacious 
injection to destroy seat-worms {Oxyuris ver- 
micularis), the infusion being injected into 
the rectum, which has been previously 
washed out with soap and water. 

The aromatic bitters are used to stimu- 
late the appetite and improve the condition 
of the digestive apparatus. The simple bit- 
ters are similarly used, but the former pos- 
sess more stimulating and tonic properties,, 
owing to their volatile and astringent con- 
stituents. Chamomile, in addition to its 
action as a stimulant to the digestion, has been employed with 
benefit in delirium tremens and as an emmenagogue, while in the 
form of hot poultices chamomile flowers serve as an efficient appli- 
cation for local pains of almost any description. 

Wild cherry might not inaptly be called a sedative tonic, its 
peculiarly bitter yet not unpleasant taste causing it to be well toler- 
ated by the stomach, and rendering it one of the best stomachic 
tonics, especially during convalescence, when its sedative action 
upon the heart allays febrile and cardiac excitement. The syrup 
of wild cherry is a common ingredient of " cough syrups." It is 
thought to quiet the cough and allay the irritability of the nervous 
system in bronchitis and phthisis. 

Serpentaria is considered an efficient expectorant in pneumoniae 




Fig. 4. — Diagram illustrating 
the action of bitters upon peri- 
stalsis : A, medulla; B, stom- 
ach; C, Auerbach's plexus; D, 
mucous membrane ; E, muscles ; 
1, motor fibers ; 2, sensory fibers. 



HEMATICS. i8i 

and capillary bronchitis. Next to its use as a stomachic its chief 
value seems to be as a stimulant in typJius and typhoid fevers, the 
compound tincture of cinchona being a most excellent remedy in 
the low forms of typhoid. The fluid extract of serpentaria is con- 
sidered somewhat of a sexual stimulant. It is a valuable applica- 
tion for poisoning by Rims toxicodendron. 

Contraindications. — i. Bitters should not be given when the 
secretion of gastric juice is diminished as the result of organic 
disease. 2. They are contraindicated as stoitiachics during the 
course of acute disease, as in fevers. 3. When, after a reasonable 
time, they fail to improve the appetite, they should be discontinued. 
4. In convalescence from acute disease, when the appetite is vora- 
cious, they are contraindicated. 5. In catarrhal conditions of the mu- 
cous membrane of the stomach — as in chronic gastritis and " drunk- 
ards' catarrh of the stomach " — alcoholic preparations of bitters, 
tinctures, etc. should not be administered, aqueous preparations 
only, like infusions, being permissible. 6. Should the digestion be 
impaired and the appetite good, it is an indication that the indiges- 
tion is intestinal, and therefore beyond the influence of bitters. 

Administration. — To improve the appetite bitters should be 
given from one-half to one hour before meals. When necessary to 
use them for a long time, one bitter should be substituted for 
another in the course of every week or two ; otherwise the stomach 
may rebel at the monotony. Bitters may be given in the form of 
a powder or a soHd extract. Ordinarily, however, it is preferable to 
administer a liquid preparation — fluid extract, tincture, or infusion. 
A pleasant method of giving the latter preparation in the case of 
quassia is to allow water to stand over-night or for a few hours in 
a quassia-cup — purchasable at almost any drug-store — when the 
water will become impregnated with the bitter principle of the 
quassia. 

GROUP VIII.— HEMATICS. 

PREPARATIONS OF IRON. 

Ferrum Reductum— Ferri Reducti— Reduced Iron. 

(Iron by Hydrogen; Quevenne's Iron.) 

Origin. — Obtained by passing Hydrogen through a hot closed 
tube containing freshly prepared and thoroughly washed Ferric 
Oxide. 



l82 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — A very fine, grayish-black, lustre- 
less powder, odorless and tasteless ; permanent in dry air ; insolu- 
ble in water or alcohol. 

Dose. — 1-5 grains (0.5-0.3 Gm.). 

Ferri Carbonas Saccharatus — Ferri Carbonatis 
Saccharati — Saccharated Ferrous Carbonate. 
77. H. r. 

Orig-in. — Prepared fi-om Ferrous Sulphate, Sodium Bicarbonate, 
Sugar, and Distilled Water, by solution and filtration. 

Description and Properties. — A greenish-brown powder grad- 
ually becoming oxidized by contact with air ; without odor, and 
having at first a sweetish, afterward a slightly ferruginous, taste. 
Only partly soluble in water, but completely soluble in hydro- 
chloric acid, with copious evolution of carbonic-acid gas, forming a 
clear, greenish-yellow liquid. The product should be kept in small, 
well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Massa Ferri Carbonatis— Massae Ferri Carbonatis 
—Mass of Ferrous Carbonate. XT. S. P. 

(Vallet's Mass.) 

Origin. — Prepared by solution, filtration, and evaporation from 
Ferrous Sulphate, Sodium Carbonate, Clarified Honey, Sugar, 
Syrup, and Distilled Water. 

Description and Properties. — When recently prepared the 
mass is of a greenish-gray color, but on exposure it becomes 
greenish-black. 

Dose. — 3-5 grains (0.15-0.3 Gm.). 

Mistura Ferri Composita— Misturae Ferri Com- 
positae— Compound Iron Mixture. Z^.S.JP. 

(Griffith's Mixture.) 

Origin. — Prepared by mixing Ferrous Sulphate, Myrrh, Sugar, 
Potassium Carbonate, Spirit of Lavender, and Rose W^ater. 

Description and Properties. — When newly prepared it is of 
a dirty greenish color, but slowly oxidizes on exposure to the air, 
and should therefore be freshly prepared when needed. 

Dose. — |-ii ounces (i 5.-45 Cc). 



HEM A TICS. 183 

Ferri lodidum Saccharatum— Ferri lodidi Saccha- 
rati— Saccharated Ferrous Iodide. U, S. JP. 

Orig"in. — Prepared by solution, filtration, evaporation, and tritu- 
ration from Iron Wire, Reduced Iron, Iodine, Distilled Water, and 
Sugar of Milk. 

Description and Properties. — A yellowish-white or grayish, 
hygroscopic, odorless powder, having a sweetish, ferruginous taste. 
Soluble in 7 parts of water, but only partially soluble in alcohol. 
It should be kept in a cool, dark place, in small, perfectly dry, 
securely-stoppered bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Pilulae Ferri lodidi— Pilulas (ace.) Ferri lodidi— Pills 
of Ferrous Iodide. JJ.S.JP. 

Origin. — Pills made of Reduced Iron, Iodine, Glycyrrhiza, Sugar, 
Extract of Glycyrrhiza, Acacia, Balsam of Tolu, Water, and Ether, 
evaporated to pilular consistence. 

Description and Properties. — These preparations are very un- 
stable, and should be kept from the Hght as much as possible. 

Dose. — One to two pills, each pill containing nearly i grain 
(0.061 Gm.) of ferrous iodide. 

Syrupus Ferri lodidi— Syrupi Ferri lodidi— Syrup of 
Ferrous Iodide. TJ. S. J*. 

Origin. — A syrup containing 10 per cent, of Ferrous Iodide. 
Description and Properties. — A transparent, pale-green liquid, 
having a sweet, strongly ferruginous taste and a neutral reaction. 
Dose. — 5-30 minims (0.3-2.0 Cc). 

Ferri Chloridum— Ferri Chloridi— Ferric Chloride. 

Orig-in. — Prepared by the action of Hydrochloric Acid and 
Distilled Water upon Iron Wire, subsequent filtration^ addition of 
Nitric Acid, and crystallization. 

Description and Properties. — Orange-yellow, crystalline pieces, 
odorless or having a faint odor of hydrochloric acid, and a strongly 
styptic taste ; very deliquescent in moist air ; freely and completely 
soluble in water or alcohol, also in a mixture of I part of ether 
and 3 parts of alcohol. Ferric chloride should be kept in glass- 
stoppered bottles protected from light. 

Dose. — It is chiefly used topically, as an astringent and hemo- 
static. 



1 84 A TEXT- BOOK OF MATERIA MEDIC A. 

Liquor Ferri Chl5ridi— Liquoris Ferri Chloridi— 
Solution of Ferric Chloride. 77. >S^. JP. 

Origin. — An aqueous solution of Ferric Chloride (FegClg^ 
323.98), containing about 37.8 per cent, of the anhydrous salt, 
corresponding to 62.9 per cent, of the crystallized salt, or about 
13 per cent, of metalHc iron. 

Description and Properties. — A reddish-brown liquid, having 
a faint odor of hydrochloric acid, an acid, strongly styptic taste, 
and an acid reaction. 

Dose. — 2-10 minims (0.12-0.6 Cc), largely diluted. 

Tinctura Ferri Ci^l5ridi— Tincturae Ferri Chloridi— 
Tincture of Ferric Chloride. TJ. S, JP. 

Origin. — A hydro-alcoholic solution of Ferric Chloride, con- 
taining about 13.6 per cent, of the anhydrous salt, corresponding 
to about 4.7 per cent, of metallic iron. 

Description and Properties. — A bright, brownish liquid having 
a sHghtly ethereal odor, a very astringent, styptic taste, and an acid 
reaction. 

Dose. — 5-30 minims (0.3-2.0 Cc). 

Liquor Ferri Acetatis— Liquoris Ferri Acetatis— 
Solution of Ferric Acetate. TJ. S. JP. 

Origin. — An aqueous solution of Ferric Acetate, containing 
about 31 per cent, of the anhydrous salt, corresponding to about 
7.5 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown, clear 
liquid, of an acetous odor, a sweetish, acidulous, somewhat styptic 
taste, and a slightly acid reaction. 

Dose. — 1-8 minims (0.06-0.5 Cc). . 

Liquor Ferri et Amm5nii Acetatis— Liqu5ris Ferri 
et Ammonii Acetatis— Solution of Iron and 
Ammonium Acetate. JJ. S. JP. 

(Basham's Mixture.) 

Pormula. — Prepared with Tincture of Ferric Chloride, 20 parts ; 
Diluted Acetic Acid, 30 ; Solution of Ammonium Acetate, 200 ; 
Aromatic Elixir, 100; Glycerin, 120; Water, to 1000. 

Dose. — 1-4 fluidrachms (4.0-15.0 Cc). 

Ferri Citras— Ferri Citratis— Ferric Citrate. U. S. I*. 

Origin. — Prepared by evaporating solution of Ferric Citrate on 
a water-bath at a temperature not exceeding 60° C. (140° F.). 



HEMATICS. 185 

Description and Properties. — Thin, transparent, garnet-red 
scales, without odor and having a sHghtly ferruginous taste. 
Slowly but completely soluble in cold water, and readily soluble 
in hot water, but diminishing in solubility with age. Insoluble in 
alcohol. Ferric citrate should be kept in well-stoppered bottles, 
protected from light. 

Dose. — 5-20 grains (0.3-1.20 Gm.), in solution. 

Liquor Ferri Citratis— Liquoris Ferri Citratis— 
Solution of Ferric Citrate. JJ, S. JP. 

Orig-in. — Prepared by precipitating a solution of Ferric Sulphate 
in Water with Ammonia Water, adding Citric Acid, filtering, and 
evaporating the filtrate to the proper amount. 

Description and Properties. — A dark-brown liquid, odorless, 
■of an acid reaction, and possessing a sHghtly ferruginous taste. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

VInum Ferri Citratis— Vlni Ferri Citratis— Wine of 
Ferric Citrate. U. S. JP. 

Composition. — Iron and Ammonium Citrate, Tincture of Sweet 
Orange Peel, Syrup, and Water. 

Dose. — J-i fluidrachm (2.0-4.0 Cc). 

Ferri et Ammonii Citras— Ferri et Amm5nii Citratis 
—Iron and Ammonium Citrate. U. S. J*. 

Origin. — Prepared by evaporating a solution of Ferric Citrate 
and Ammonia Water. 

Description and Properties. — Thin, transparent, garnet-red 
scales, odorless, and having a sahne, mildly ferruginous taste ; 
deliquescent in moist air. Completely soluble in water, but 
insoluble in alcohol. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Ferri et Quinlnae Citras— Ferri et Quinlnae Citratis 
—Iron and Quinine Citrate. U. S. P. 

Origin. — Solution of Ferric Citrate in Distilled Water and 
solution of Quinine and Citric Acid in Distilled Water are mixed, 
evaporated on a water-bath to the consistence of syrup, and dried 
on plates of glass. 

Description and Properties. — Thin, transparent scales, of a 



I86 A TEXT-BOOK OF MATERIA MEDICA, 

reddish-brown color, without odor, and having a bitter, mildly 
ferruginous taste ; slowly deliquescent in damp air. Gradually but 
completely soluble in cold water, more readily soluble in hot water, 
and but partially soluble in alcohol, its solubility diminishing with 
age. It should be kept in well-stoppered bottles, protected from 
light. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Ferri et Quinlnae CTtras Solubilis— Ferri et Quinlnae 
Citratis Solubilis— Soluble Iron and Quinine 
Citrate. V. S. I". 

Origin. — Prepared in the same manner as the above salt, but 
with the addition of Ammonia Water. 

Description and Properties. — Thin, transparent scales, of a 
greenish, golden-yellow color, odorless, and having a bitter, mildly 
ferruginous taste ; deliquescent in damp air. Rapidly and com- 
pletely soluble in cold water, but only partially soluble in alcohol. 
It should be kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Ferri et Strychnlnae Citras— Ferri et Strychninae 
Citratis— Iron and Strychnine Citrate. U, S. JP. 

Origin. — Solution of Iron and Ammonium Citrate in Distilled 
Water and solution of Strychnine and Citric Acid in Distilled 
Water are mixed, evaporated to the consistence of syrup by means 
of a water-bath, and dried on plates of glass. 

Description and Properties. — Thin, transparent scales, varying 
in color from garnet-red to yellowish-brown, without odor, and 
having a bitter, slightly ferruginous taste ; deliquescent in damp 
air. Readily and completely soluble in water, but only partly sol- 
uble in alcohol. It should be kept in well-stoppered bottles, pro- 
tected from light. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

VTnum Ferri Amarum— VIni Ferri Amari— Bitter 
Wine of Iron. U. S. I>. 

Coraposition. — Soluble Iron and Quinine Citrate, Tincture of 
Sweet Orange Peel, Syrup, White Wine. 
Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 



HEMATICS. 187 

Syrupus Ferri, Quinlnae, et Strychnlnae Phospha- 
tum— Syrupi Ferri, Quimnse, et Strychnlnae 
Phosphatum— Syrup of the Phosphates of Iron, 
Quinine, and Strychnine. TJ» S. JP, 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 



Ferri Lactas— Ferri Lactatis— Ferrous Lactate. 

V. s. p. 

Description and Properties. — Pale, greenish-white crusts, con- 
sisting of small, needle-shaped crystals, having a slight, peculiar 
odor, and a mild, sweetish, ferruginous taste. Slowly but com- 
pletely soluble in 40 parts of water and in 12 parts of boiling 
water; almost insoluble in alcohol. Ferrous lactate should be 
kept in well-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Syrupus Hypophosphltum cum Ferro— Syrupi Hy- 
pophosphitum cum Ferro— Syrup of Hypophos- 
phites with Iron. U. S, P. 

Ferrous Lactate and Potassium Citrate dissolved in Syrup of 
Hypophosphites. 

.Dose. — i— I fluidrachm (2.0-4.0 Cc). 

Ferri Oxidum Hydratum— Ferri Oxidi Hydrati— 
Ferric Hydrate. U.S.JP. 

(Ferric Hydroxide — Hydrated Oxide of Iron.) 

Origin. — To a solution of Ammonia Water in Water is added a 
solution of Ferric Sulphate in Water, and the precipitate collected. 

Description and Properties. — A brownish-red magma, wholly 
soluble in hydrochloric acid, without effervescence. 

Dose. — 4 drachms (16 Gm.), or ad libitum in case of arsenical 
poisoning. 

Ferri Oxidum Hydratum cum Magrnesia— Ferri 
Oxidi Hydrati cum Magnesia— Ferric Hydrate 
with Magnesia. JJ. S. JP. 

Solution of Ferric Sulphate, Magnesia, and Water. 
Dose. — Amounts as necessary ad libitum. 



l88 A TEXT-BOOK OF MATERIA MEDICA, 

Ferri et Ammonii Sulphas— Ferri et Ammonii Sul- 
phatis— Ferric Ammonium Sulphate. TJ* S. JP. 

(Ammonio-ferric Sulphate — Ammonio-ferric Alum.) 
Orig-in. — The crystals formed by adding Ammonium Sulphate 
to a boiling-hot solution of Ferric Sulphate. 

Description and Properties. — Pale violet, octahedral crystals, 
odorless, and having an acid, styptic taste ; efflorescent on exposure 
to the air. Soluble in 3 parts of water and in 0.8 part of boiling 
water ; insoluble in alcohol. The product should be kept in well- 
stoppered bottles. 

Dose. — 5-15 grains (0.5-1.0 Gm.). 

Ferri et Ammonii TS.rtras— Ferri et Ammonii Tar- 
tratis— Iron and Ammonium Tartrate. U. S, JP. 

(Ammonio-ferric Tartrate.) 

Description and Properties. — Thin, transparent scales, varying 
in color from garnet-red to reddish-brown, without odor, and 
having a sweetish, slightly ferruginous taste ; slightly deliquescent 
in the air. Very soluble in water ; insoluble in alcohol. Iron and 
ammonium tartrate should be kept in well-stoppered bottles, pro- 
tected from light. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Ferri et Potassii Tartras— Ferri et Potassii Tar- 
tratis— Iron and Potassium Tartrate. U. S. JP. 

(POTASSIO-FERRIC TARTRATE.) 

Description and Properties. — Thin, transparent scales, vary- 
ing in color from garnet-red to reddish-brown, without odor, and 
having a sweetish, slightly ferruginous taste ; slightly deliquescent 
in the air. Very soluble in water ; insoluble in alcohol. It should 
be kept in well-stoppered bottles, protected from Hght. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Ferri Phosphas Solubilis— Ferri Phosphatis Solu- 
biiis— Soluble Ferric Phosphate. U. S. JP. 

Description and Properties. — Thin, bright-green, transparent 
scales, odorless, and having an acidulous, slightly saline taste. The 
salt is permanent in dry air when excluded from light, becoming 
dark and discolored when exposed to it. Freely and completely 



HEM A TICS. 189 

soluble in water, but insoluble in alcohol. It should be kept in 
dark amber-colored, well-stoppered bottles. 
Dose. — 5-10 grains (0.3-0.6 Gm.). 



Ferri Pyrophosphas Solubilis— Ferri Pyrophospha- 
tis Solubilis— Soluble Ferric Pyrophosphate. 

JJ. S. JP. 

Description and Properties. — Thin apple-green, transparent 
scales, without odor, and having an acidulous, slightly saline taste ; 
permanent in dry air if protected from light, and if exposed to it 
becoming dark and discolored. Freely and completely soluble in 
water, but insoluble in alcohol. It should be kept in dark amber- 
colored, well-stoppered bottles. 

Dose. — 2-5 grains (0.1-0.3 Gm.). 



Ferri Hypophosphis— Ferri Hypophosphitis— Ferric 
Hypophosphite. U. S. J*. 

Origin. — The precipitate formed by mixing solutions of Sodium 
Hypophosphites and Ferric Chloride or Ferric Sulphate. 

Description and Properties. — A white or grayish-white pow- 
der, odorless and nearly tasteless, permanent in the air. Only 
slightly soluble in water. It should be kept in well-stoppered 
bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 



Ferri Valerianas— Ferri Valerianatis— Ferric 
Valerianate. V. S. r. 

Orig-in. — The precipitate obtained by adding to a cold solution 
of Ferric Sulphate or Ferric Chloride a cold solution of Sodium 
Valerianate. 

Description and Properties. — A dark, brick-red, amorphous 
powder, of somewhat varying chemical composition, having the 
odor of valerianic acid and a mildly styptic taste; permanent in 
dry air. Insoluble in cold water, but readily soluble in alcohol. 
Boiling water decomposes it, setting free the valerianic acid and 
leaving ferric hydrate. It should be kept in small, well-stoppered 
bottles, in a cool, dark place. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 



190 A TEXT-BOOK OF MATERIA MEDICA. 

Ferri Sulphas— Ferri Sulphatis— Ferrous Sulphate. 

TI. S. jP. 

Origin. — Obtained by the action of Sulphuric Acid and Water 
upon Iron Wire. 

Description and Properties. — Large, pale bluish-green mono- 
clinic prisms, without odor, and having a saline, styptic taste; 
efflorescent in dry air ; on exposure to moist air the crystals rap- 
idly absorb oxygen, becoming coated with a brownish-yellow, 
basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part 
of boiling water ; insoluble in alcohol. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 



Ferri Sulphas Exsiccatus— Ferri Sulphatis Exsic- 
cati— Dried Ferrous Sulphate. U, S, JP. 

Description and Properties. — A grayish-white powder, slowly 
but completely soluble in water. 

Dose. — 1—2 grains (0.03-0.12 Gm.). 



Ferri Sulphas Granulatus— Ferri Sulphatis Granu- 
lati— Granulated Ferrous Sulphate. (J. S. JP. 

Description and Properties. — A pale bluish-green, crystallized 
powder, which should conform in every respect to the reactions 
and tests given under Ferri Sulphas in the U. S. P. 

Dose. — 1-3 grains (0.03-0.18 Gm.). 



Liquor Ferri Subsulphatis— Liquoris Ferri Subsul- 
phatis— Solution of Ferric Subsulphate. U. S. I*. 

(Solution of Basic Ferric Sulphate — Monsel's Solution.) 

Origin. — An aqueous solution of basic Ferric Sulphate — of 
varying chemical composition — corresponding to about 13.6 per 
cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, 
odorless or nearly so, of an acid, strongly styptic taste, and an 
acid reaction. Miscible with water and alcohol in all proportions, 
without decomposition. 

Dose. — i-io minims (0.06-0.6 Cc), largely diluted — chiefly 
used, however, as a local styptic. 



HEMATICS. 191 

Liquor Ferri Tersulphatis— Liquoris Ferri Tersul- 
phatis— Solution of Ferric Sulphate. TJ, S. J*. 

Orig-in. — An aqueous solution of normal Ferric Sulphate, con- 
taining about 28.7 per cent, of the salt, and corresponding to about 
8 per cent, of metallic iron. 

Description and Properties. — A dark, reddish-brown liquid, 
almost odorless, having an acid, strongly styptic taste, and an acid 
reaction. Miscible with water and alcohol in all proportions, with- 
out decomposition. 

Dose. — i-io minims (0.06-0.6 Cc), given in the same manner 
and for the same purposes as the preceding preparation. 

Pilulae Aloes et Ferri— Pilulas (ace.) Aloes et Ferri— 
Pills of Aloes and Iron. U. S. I". 

Described under Aloes. 

Dose. — 5-10 grains (0.3-0.6 Gm.), or two or three pills. 

Emplastrum Ferri— Emplastri Ferri— Iron Plaster. 

V. S. I". 

(Strengthening Plaster.) 

Formula : Ferric Hydrate, 90 ; Olive Oil, 50 ; Burgundy Pitch, 
140; Lead Plaster, 720. For external use. 

TrochTsci Ferri— TrochTscos (ace.) Ferri— Troches of 

Iron. 77. S. JP. 

Coraposition. — Ferric Hydrate; Vanilla; Sugar; Mucilage of 
Tragacanth. 

Dose. — One to two troches, each troche containing 5 grains 
(0.3 Gm.) of ferric hydroxide. 

Liquor Ferri Nitratis— Liquoris Ferri Nitratis— 
Solution of Ferric Nitrate. U. S. J». 

Origin. — An aqueous solution of Ferric Nitrate, containing 
about 6.2 per cent, of the anhydrous salt, corresponding to about 
1.4 per cent, of metallic iron. 

Description and Properties. — A clear, amber-colored or red- 
dish liquid, odorless, having an acid, styptic taste, and an acid reaction. 

Dose. — 5-10 minims (0.3-0.6 Cc). 



192 A TEXT-BOOK OF MATERIA MEDICA. 

PTIulae Ferri Carbonatis— Pilulas (ace.) Ferri Car- 
bonatis— Pills of Ferrous Carbonate. TJ. S. JP. 

(Ferruginous Pills — Chalybeate Pills — Blaud's Pills.) 
Dose. — 2 to 5 pills, each pill containing i grain (0.064 Gm.) 
of ferrous carbonate. 

Unofficial Preparations. 

Tinctura FSrri Acetatis — Tincturae FSrri Acetatis — Tincture of Ferric Ace- 
tate, U. S. P. — Composition: Solution of Ferric Acetate; Alcohol; Acetic Ether, 

Description and Properties. — A clear, dark, reddish-brown liquid, transparent in 
thin layers, having the odor of acetic ether, an acidulous and astringent taste, and a 
slightly acid reaction. Miscible in all proportions with water, without becoming turbid. 
The tincture should be kept in the dark and in a cool place. 

Dose. — 5-30 minims (0.2-2.0 Cc). 

FSrri Arsenas — FSrri Arsenatis — Iron Arsenate. — Description and Proper- 
ties. — A green or blue-green, amorphous powder, insoluble in water and in alcohol. 

Dose. — ^Q-\ grain (0.003-0.03 Gm.). 

FSrri Albuminas — FSrri Albuminatis — Albuminate of Iron. — Description 
and Properties. — Golden yellow, transparent scales, containing 3.34 per cent, of iron. 

Dose, — 5-30 grains (0.3-2.0 Gm.). A liquor and a syrup of albuminate of iron 
are used. 

FSrrum Dialysatum — FSrri Dialysati — Dialyzed Iron (Liquor Ferri Dia- 
LYSATUS — Liquor Ferri Oxychlorati). — Description and Properties. — Perfectly 
transparent, thin layers, of a deep brown-red color, inodorous, and almost destitute of 
styptic taste. Miscible with alcohol, glycerin, syrup, and distilled water, but not with 
spring-water or other, even dilute, saline solutions. 

Dose. — 10-30 minims (0.6-2.0 Cc). 

Liquor FSrri Peptonati — Liquoris FSrri Peptonati — Solution of Peptonate 
of Iron. — Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Liquor MSngano-FSrri Peptonatus — Liquoris M^ngano-Fferri Peptonati 
(Gude) — Solution of Peptonate of Iron and Manganese. — A proprietary prepa- 
ration from the formula of Dr. Gude. 

Dose. — 2-4 fluidrachms (8.0-15.0 Cc). 

Allied Compounds. 

Haemogallol. — Origin. — Prepared by the action of Pyrogallol on the coloring 
matter of the blood. 

Description and Properties. — A reddish-brown, tasteless powder. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Hsemol. — Origin. — Prepared by the action of Zinc Dust on the coloring matter 
of the blood. 

Description and Properties. — A blackish-brown powder having a slight taste. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Ferratin. — Origin. — A compound of Iron first obtained by Professor Schmiedeberg^ 
from hog's liver. 

Description and Properties. — A fine, reddish-brown powder containing about 7 per 
cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in 
water. 



HEMATICS. 193 

Dose. — 10-20 grains (0.16-1.2 Gm.). 

Haem albumin. — A preparation said to contain two albuminoids and salts of the 
blood. 

Description and Properties. — A permanent powder, soluble in water and in alcohol. 

Dose. — 5-15 grains (0,3-1.0 Gm.). 

Haennoglobin, — Said to be the coloring principle of the solid elements of the blood. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Haemoferrum. — Claimed to be a natural proteid compound of Iron obtained from 
bullock's blood. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Iron Quinine Chloride. — A yellowish-red powder, soluble in water, alcohol, and 
glycerin. 

Dose. — 1-3 grains (0.06-0. 18 Gm.). Used externally as a hemostatic. 



Antag-onists and Incompatibles. — The ferric salts are incom- 
patible with tannic and gallic acids and vegetable astringents, and 
gelatinize mucilage of acacia. The carbonates are also incompatible 
with tannic and mineral acids and acidulous salts. 

The salts of the vegetable acids and the iodides are incompatible 
with mineral acids, tannic acid, and with alkalies and their carbon- 
ates. The tincture of the chloride of iron is also incompatible 
with tannic acid, vegetable astringents, alkalies and their carbon- 
ates, lime water, and the carbonates of calcium and magnesium. 

Synergists. — All the restorative medicines are synergistic. 

Physiolog'ical Action. — Iron is a typical restorative, being an 
essential element of the blood, there being i part of iron to 230 
of red globules. It has also been found in the gastric juice, bile, 
lymph, chyle, milk, urine, pigment of the eye, etc. This omni- 
presence is readily accounted for when it is remembered that the 
food of man contains iron in variable quantities. Indeed, this use- 
ful metal may well be called a respiratory nutrient because of its 
property of increasing the oxygen-carrying power of the red blood- 
corpuscles — muscular force and functional activity generally being 
dependent upon the supply of oxygen, or proper respiration, as 
the motive power. 

When the system is in a normal, healthy condition, sufficient 
iron is furnished by the mixed diet to answer all physiological 
requirements. In many diseased conditions, however, there is a 
deficiency of iron, and it is necessary to restore this element in 
one way or another. 

The chief actions of iron are — I. To increase the oxygen- 
carrying powers of the blood ; 2. To convert the oxygen present 
in the tissues into ozone ; 3. To serve both as a local and general 
astringent. 

13 



194 A TEXT-BOOK OF MATERIA MEDICA. 

The physiological effects upon the various systems, locally and 
internally, now to be considered, are due directly or indirectly to 
the principal actions above mentioned. 

Externally and Locally. — Neither the ferric nor the ferrous salts 
exert any action upon the unbroken skin. When appHed, however, 
to mucous membranes or denuded surfaces, they are astringent and 
hemostatic, the ferric salts being the more powerful, coagulating 
albuminous fluids. When applied to bleeding surfaces the hemo- 
static action is due rather to the coagulation of the blood, forming 
a natural barrier to its escape, than to any direct action upon the 
walls of the vessels. The vegetable salts — scale preparations — 
possess so feeble astringent properties that they are rarely, if ever, 
used as local apphcations. 

The acid and astringent preparations of iron act upon the teeth. 
The ferric oxides are disinfectant, owing to their property of con- 
verting oxygen into ozone. 

Internally. — Digestive System. — The teeth and tongue are black- 
ened by the preparations of iron. In the stomach, when not con- 
traindicated and in small doses, its slightly irritant and astringent 
properties render iron quite a valuable stomachic tonic. Under 
excessive doses or prolonged administration the acid preparations 
especially are apt to cause gastric derangement — anorexia, nausea, 
and serious indigestion. The ferric chloride is particularly valu- 
able in that its ingestion does not, like that of other preparations 
of iron, diminish the supply of hydrochloric acid in the gastric juice. 

The scale salts, though disturbing the digestion less than the 
acid preparations, are ordinarily inferior to the latter. 

All the preparations of iron are probably converted into the 
chloride in the stomach. When entering the intestines they are 
converted into the ferric oxide, ferrous chloride, the alkaline albu- 
minate, and the insoluble sulphide and tannate. Most of the iron 
preparations are constipating, the phosphate and pyrophosphate 
being exceptions. They tend to diminish the bile and the secre- 
tions from the gastro-intestinal tract. 

Cirailatory System. — The action of iron upon the blood is of 
great importance, since, the metal being a normal constituent 
of that fluid, its administration has a nutrient as well as a medicinal 
influence. A primary effect is to supply a deficiency of red cor- 
puscles and bring the hemoglobin up to the normal standard. 
Iron enables the red corpuscles to convey more oxygen to the 
tissues, converting that element into ozone and thereby rendering it 



HEMATICS. 195 

more active in promoting oxidation. The muscular power of the 
heart is increased, the arterioles slightly contracted, and arterial 
tension somewhat raised. 

Nervous System. — The general effect is tonic, the influence of 
iron and its salts being highly beneficial in strengthening the action 
of the nerves in cases of physical debility. With subjects inclined 
to plethora, however, certain untoward symptoms may result from 
administration of the stronger preparations, including a feeling of 
congestion in the cerebrum. 

Respiratory System. — No immediate action is perceptible under 
normal conditions, but in anemic states, by supplying the nerve- 
centers, muscles, and lungs with better blood, the respiratory power 
is increased. 

Absorption and Elimination. — Opinions differ regarding the form 
in which iron is absorbed. Probably much of it is converted into 
the soluble chloride and absorbed as such, while a portion, passing 
into the intestines, may there be converted into the soluble alka- 
line albuminate capable of absorption. The larger portion of iron 
taken into the system, however, is changed into the insoluble sul- 
phide and tannate, and excreted as such, giving to the feces a 
black color. Such part of the iron as enters the circulation com- 
bines with the red corpuscles. The salts of the organic acids 
are absorbed directly into the blood. 

Such careful pharmacologists as Bunge, Schmiedeberg, and 
Hamburger claim that inorganic preparations of iron are neither 
absorbed nor assimilated, maintaining that the blood and hemo- 
globin are influenced only by the organic compounds. Yet, not- 
withstanding these statements, clinical experience has fully demon- 
strated the value of such preparations as reduced iron, tincture of 
the chloride, carbonate, etc. ; and it is still perhaps a mooted ques- 
tion whether appreciable amounts of them are actually absorbed, 
or whether, according to Bunge, the inorganic prevent the decom- 
position of the organic salts of iron in the food by fixing the 
decomposing agents in the intestines. At all events, the beneficial 
results in anemia and chlorosis of large doses of the inorganic 
preparations are too manifest to justify abandonment of these 
agents because of our ignorance touching their modus operandi. 

Bunge's hypothesis would at least seem plausible when it is 
remembered that only traces of iron can be found in the urine 
when the drug is given by the stomach, while if injected into the 
circulation large quantities are eliminated by the kidneys. It is 



196 A TEXT-BOOK OF MATERIA MEDICA. 

quite possible that the improvement in the red corpuscles, and the 
promotion of oxidation independent of them, take place in the 
portal circulation, and that when the iron reaches the liver it is 
there intercepted and, together with the bile, turned back into the 
intestines. 

The amount of urea is increased and micturition rendered more 
frequent by preparations of this metal. 

EHmination takes place chiefly by the feces, to which a blackish 
color is imparted by the formation of ferrous sulphide. The bile^ 
urine, and even the skin, as well as the mucous and serous mem- 
branes, share in the excretory process. 

Temperature. — The administration of iron tends to raise bodily 
heat. This, however, may be due only to the normal influence 
of the metal, the ozonizing power of which, affecting the promo- 
tion of tissue-waste, naturally causes an elevation of temperature. 

Untoivard Action. — The continued use of ferruginous prepara- 
tions has a tendency to impair the normal digestive powers, occa- 
sioning even gastric oppression, nausea, and vomiting. Reduced 
iron, the phosphate, and the pyrophosphate produce less untoward 
action than other preparations, and the ferrous are better tolerated 
than the ferric salts. Not infrequently acne of the face, breast,, 
and back is occasioned, while the prolonged administration of the 
drug may in rare cases be accompanied by hemorrhages from 
the mucous membranes and symptoms of plethora and vascular 
excitement. Large doses of the ferrous sulphate may occasioni 
obstruction of the bowels. 

Poisoning. — The ferric preparations in a concentrated form pro- 
duce all the symptoms of an irritant poison — gastric pain, vomit- 
ing, etc. 

Treatment of Poisoning. — The stomach should be emptied by^ 
an emetic or carefully cleansed, the treatment being followed by 
the administration of alkah solutions, tannic acid, and demulcent 
drinks, the procedure being similar to that employed in poisoning 
from mineral acids. 

Therapeutics. — Externally and Locally. — The astringent and 
styptic properties of chlorides and sulphates of iron have rendered 
them serviceable in controUing hemorrhage and as local astrin- 
gents in relaxed conditions of the pharynx and larynx and mucous 
membranes generally. The tincture of the chloride has been 
highly recommended as a local application to the throat in diph- 
theria^ and cJironic and indolent ulcers may often be benefited \yf 



HEMATICS. . 197 

a wash containing from 2 to 5 grains (0.12-0.3 Gm.) of the sulphate 
to I ounce (30.0 Cc.) of water. 

Internally. — The most important use of iron is to restore the 
number of red corpuscles. In nearly every form of anemia, there- 
fore, iron is indicated. In clilorosis, especially, it is of great value ; 
but in order that its effects may be most beneficial, cathartics, such 
as rhubarb and aloes, which do not weaken the intestines should 
accompany its use. Even the anemia due to Jiemorrhage calls for 
iron ; yet if the assimilative functions are not impaired, the drug 
should be reinforced by plenty of nutritious food, from which the 
constituents of the blood are normally elaborated. 

The anemia of scrofula and syphilis is benefited by some form 
of iron, care being taken in these cases to select the proper salts. 
In glandular scroftda, for instance, the iodide is to be preferred, 
and, theoretically, this salt is preferable also in syphilis, yet in the 
latter disease the efficacy of the salt depends less upon its particular 
radical than upon its restorative properties and its power of counter- 
acting the depressing and mischievous effects so often produced by 
excessive use of the specific. 

In the desquamative forms of Bright' s disease iron is of signal 
benefit. In this condition the blood-disks are rapidly destroyed 
by the urea ; moreover, certain preparations of iron possess quite 
a local action upon the kidney. Iron is also useful in jaundice 
where there is more or less cholemia, with destruction of the red 
corpuscles. 

Many itervozcs disorders dependent upon anemia are relieved by 
iron. Even in chorea and various neuralgias — especially those of 
an intermittent nature arising from an impoverished state of the 
blood — iron is of decided value. In many chronic nervous diseases, 
however, good judgment in the use of the drug is necessaiy, lest 
it prove more prejudicial than advantageous. 

In anemia of certain cardiac diseases iron is of unquestioned 
value, though the fact is well known to observant practitioners that 
in these cases iron alone is but a single element in the successful 
treatment of them. 

While iron is of great service in lessening the muco-purulent 
expectoration of chrojiic bronchitis, its influence in pulmonary tuber- 
cidosis is less favorable. At times, it is true, the drug appears to 
improve the condition of phthisical patients, yet more frequently 
it induces hemoptysis and hastens the progress of the disease. In 
certain disorders of the genito-urinary tract — prolapsus uteri, incon- 



198 A TEXT-BOOK OF MATERIA MEDICA. 

tinence of urine, seminal emissions, prostatorrhea, etc. — iron is an 
appropriate remedy. It is an important agent in the treatment 
of diabetes, though care should be taken to guard against its 
tendency to constipate the bowels. 

As observed later on, iron is contraindicated in febrile diseases, 
yet it is a matter of clinical experience that the drug acts favorably 
in modifying the course of idiopathic erysipelas, pyemia, septicemia, 
and diphtheria. 

The astringent action of iron is available in the treatment of 
vaginal leucorrhea, hematemesis, and passive hemorrhages from the 
uterus, bladder, kidneys, etc. It has also proved highly beneficial 
in certain forms of chronic diarrhea and dysentery. In amenorrhea 
and menorrhagia, when due to a deficiency of normal blood, iron 
is an extremely valuable remedy. 

Contraindications. — ^Iron is usually contraindicated in fever 
and acute inflammatory conditions, in anemia of malignant disease, 
such as cancer, in Addison's disease, and in the hemorrhagic diath- 
esis. Should the use of iron derange digestion or aggravate 
hemorrhoidal conditions, the drug should be discontinued or care- 
fully administered, being associated with stomachics or laxatives 
to mitigate its untoward effects. 

Administration.— If the appetite be poor, iron should be ad- 
ministered in small doses (invariably after meals) or preceded by 
vegetable bitters. The tincture of the chloride and the stronger 
preparations should be freely diluted with water. The citrate of 
iron is a mild preparation well adapted for children and persons of 
delicate stomach. 

Probably the salt richest in iron, yet of all the ferruginous 
preparations the most agreeable and least irritating, is the iron and 
potassium tartrate. The soluble ferric pyrophosphate is also a 
mild and pleasant preparation. The compound iron mixture pos- 
sesses special advantages in the treatment of chlorosis and chronic 
diseases of the skin, while the solution of iron and ammonium 
acetate (Basham's mixture) is the best preparation in albuminuria — 
particularly that accompanying tubular nephritis — it being agree- 
able and well tolerated. 

The best styptic is the ferric subsulphate or its solution. 

Dialyzed iron, being agreeable to the taste, was formerly a pop- 
ular remedy. 

Some of the allied compounds above mentioned are very useful. 
The ferratin especially is a most valuable compound of iron, while 



HEMATICS. 199 

the liquor mangano-ferri peptonatus is an agreeable and efficient 
remedy, having no deleterious effect upon digestion, but, on the 
contrary, actually improving the appetite. 

Mangranum—Mangrani— Manganese. 

This metal is a normal constituent of the body, existing in ap- 
preciable though minute quantities in the blood, bile, etc. From 
the fact of its presence in the blood, and because of the similarity 
of its chemical affinities to those of iron, theorists, rather than 
careful and practical observers, have advocated its use as a worthy 
and efficient substitute for the latter agent. 

Its therapeutic uses as a restorative, or as an alternative or 
synergist to iron, are based more upon abstract deductions than 
upon clinical observation. Still, as its chemical character resem- 
bles that of iron — though the metal in its operation is often 
antagonistic to the latter — its salts are of sufficient therapeutic 
importance to merit brief mention here. 

Mangani Dioxidum— Mangani Dioxidi— Manganese 
Dioxide. V. H. JP. 

(Black Oxide of Manganese.) 

Origin. — Native, crude manganese dioxide, containing at least 
66 per cent, of the pure dioxide. 

Description and Properties. — A heavy, grayish-black, more or 
less gritty powder, without odor or taste ; permanent in the air ; 
insoluble in water or alcohol. 

Dose. — 5-40 grains (0.3-3.0 Gm.). 

M^ngani Sulphas— Mangani Sulphatis— Manganese 
Sulphate. U. S. I". 

Origin. — Obtained by heating Manganese Dioxide with suf- 
ficiently strong Sulphuric Acid, evaporation, and crystallization. 

Description and Properties. — Colorless or pale rose-colored, 
transparent, tetragonal prisms, odorless, and having a slightly bitter 
and astringent taste ; slightly efflorescent in dry air. Soluble in 
0.8 part of water and in i part of boiling water ; insoluble in alco- 
hol. Manganese sulphate should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (0.1-0.3 Gm.). 

(For Potassium Permanganate see section on Antiseptics) 

Antagonists and Incompatibles. — The salts of lead, silver, and 
mercury are incompatible with manganese. 



200 A TEXT-BOOK OF MATERIA MEDIC A. 

Synerg'ists. — Iron is theoretically synergistic, and the salts of 
zinc, copper, and silver are similar in their action on the nervous 
system. 

Physiolog'ical Action. — Externally and Locally. — The two salts 
above mentioned have no important local action. 

Internally. — In large doses these salts, especially the sulphate, 
irritate the gastro-intestinal tract, while excessive doses may even 
occasion gastro-enteritis. The sulphate acts as an emeto-cathartic 
and possesses cholagogue properties. 

As is the case with many other drugs of this character, small 
doses may even promote the appetite and improve the digestive 
function. Large doses, or the continued administration of these 
preparations, affects the system more like zinc than iron, pro- 
ducing great depression, muscular weakness and waste, diminishing 
the pulse-beat, weakening the heart, and lowering arterial tension. 
There is, moreover, a tendency to fatty degeneration of the muscles 
and liver. 

Therapeutics. — The manganese dioxide has been used in the 
treatment of gastralgia, pyrosis^ and simple ulcer of the stomach. 
Its action probably resembles that of bismuth, though it is a much 
less efficient remedy than the latter drug. 

The sulphate is used occasionally as a cholagogue purgative in 
malarial jaundice, although why it should be preferred to many 
other and superior cholagogues it is difficult to understand. Gouty 
dyspepsia appears to have been much improved by the use of 
manganese. The association of iron and manganese makes a 
valuable combination in the treatment of chlorosis and many 
variations of a^iemia. 



Phosphorus— Phosphori— Phosphorus. TJ. S. B. 

Orig-in. — It exists, chiefly as phosphates, in many minerals and 
in all plants and animals. It is prepared by treating Calcined 
Bones with Sulphuric Acid, evaporation, and distillation. 

Description and Properties. — A translucent, nearly colorless 
soHd, of a waxy luster, having at ordinary temperatures about the 
consistence of beeswax. When kept for some time the surface 
becomes red and occasionally black. Phosphorus has a distinctive 
and disagreeable odor and taste {tasting being allowable only in the 
fonn of extreme dilution). When exposed to the air it emits white 
fumes, visible in the dark, and having an odor somewhat resembhng 



HEMATICS. 20 1 

that of garlic. Upon prolonged exposure to air it takes fire spon- 
taneously. 

Phosphorus is insoluble, or nearly so, in water, to which, how- 
ever, it imparts its characteristic disagreeable odor and taste. It is 
soluble in 350 parts of absolute alcohol, in 80 parts of absolute 
ether, and in about 50 parts of any fatty oil. It is very soluble in 
chloroform or in carbon disulphide, the latter yielding a solution to 
be handled with the greatest care to prevent accident from combus- 
tion. The drug should be carefully kept under water, in strong, 
well-closed vessels, in a secure and moderately cool place protected 
from light. 

Dose. — x"OT~Xo g^^i^ (0.0006-0.002 Gm.). 

Official Preparations. 

Oleum Phosphoratum — Olei Phosphorati — Phosphorated Oil. — Dose, 1-5 
minims (0.06-0.3 Cc). A clear, yellowish liquid, having the odor of phosphorus and 
of ether, but not phosphorescent in the dark. It should be perfectly free from particles 
of undissolved phosphorus. 

Pilulae Ph6sphori — Pilulas (ace.) Ph6sphori — Pills of Phosphorus. — Dose, 
one to two pills. Each pill contains yi^ grain (0.0006 Gm.) of phosphorus. 

Spiritus Ph6sphori — Spiritus Ph6sphori — Spirit of Phosphorus (Tincture 
OF Phosphorus). — Dose, 5-30 minims (0.3-2.0 Cc). 

Elixir Ph6sphori — Elixir Ph6sphori — Elixir of Phosphorus. — Dose^ i-2 fluid- 
drachms (2.0-8.0 Cc). 

Antagonists and Inconipatibles. — The principal chemical anti- 
dotes are hydrated magnesia, Hme water, powdered charcoal, cop- 
per sulphate, and old acid turpentine. 

Synergists. — Cod liver oil and the Restoratives generally aid 
the action of phosphorus. It is claimed that arsenic and sulphur 
are also synergistic. 

Physiological Action. — Exter7tally aitd Locally. — Applied to 
the skin, phosphorus causes local inflammation, ulceration, and 
possibly gangrene. The fumes may produce the most serious 
results — even maxillary necrosis where dental caries is present, as 
well as great irritation of the conjunctivae and the respiratory 
mucous membrane. The graver systemic symptoms are confined 
to the conditions induced by toxic doses of the drug. 

Internally. — Digestive System. — Taken into the stomach, no 
special effect is apparent as a result of small doses, save that the 
drug acts as a functional stimulant. Larger amounts have been 
held to impede digestion by impairing the action of the gastric 
juice upon albuminoid materials. Immoderate doses occasion 



202 A TEXT-BOOK OF MA TERIA MEDICA. 

great irritation of the stomach and intestines, accompanied by 
abdominal distress, vomiting, and purging. Jaundice is a not 
infrequent result of ingestion, due to obstruction of the biliary 
ducts. Minute quantities stimulate the nutrition of the tissues^ 
especially that of the osseous system. 

Circulatory System. — The primary action is stimulating, the 
pulse rising and acquiring additional force, though not firmness. 
The facial capillaries are expanded, often congested ; the cutaneous 
circulation becomes more rapid ; and diaphoresis is produced. 
Under toxic doses the action of the heart is strongly depressed. 

Nervous System. — In repairing the waste of tissue phosphorus 
acts upon the nervous system as a tonic, improving the nutritioa 
of debilitated parts and restoring to normal conditions the func- 
tional activity of organs and tissues. Small or moderate doses act 
as stimulants to the entire nervous system, intellectual activity 
being promoted and the sexual appetite increased. Toxic effects, 
include coma, and occasionally vertigo, with deHrium, convulsions^ 
insensibility, and collapse. 

Respiratory System. — The deleterious action of the fumes of 
phosphorus is exemplified in their irritating effect upon the broncho- 
pulmonary mucous membrane. Toxic symptoms are often accom- 
panied by serious disturbances, respiratory failure being among the 
immediate causes of death. 

Absorption and Elimination. — The modus operandi of absorption 
is a matter of some dispute. Probably a portion of the drug 
undergoes oxidation in the stomach, and the phosphoric acid 
formed, combining with the alkalies, enters the blood as phos- 
phates. A part of the phosphorus is dissolved in the fats and oils 
present in the stomach, probably entering the circulation as ele- 
mentary phosphorus. 

The drug, having undergone oxidation in the system, is elim- 
inated as phosphoric acid, chiefly by the urine, increasing the 
excretion of urinary phosphates. The Hver shares in the excretory 
process. 

Temperature. — Owing to capillary expansion, the superficial 
temperature is at first slightly raised, being subsequently dimin- 
ished. Evaporation and radiation, arising from profuse diaphoresis, 
contribute to thermal reduction. 

Eye. — In chronic poisoning from phosphorus hemorrhages and 
patches of degeneration in the retina are sometimes visible, the 
ophthalmoscopic picture resembling the retinitis of albuminuria. 



HE MA TICS, 203 

Under medicinal doses no special effects upon the eye are reported, 
although, as has been stated, the vapor of phosphorus is highly 
irritant to the conjunctivae. 

Uterus. — The action of phosphorus tends to increase the men- 
strual flow. 

Untoward Action. — Small doses produce in some individuals 
severe gastric disturbance, and in rare cases diarrhea, tenesmus, 
and jaundice. The fatty degeneration of the retinal capillaries 
mentioned above — such as results from chronic intoxication affect- 
ing workers in match-factories — is an untoward manifestation to 
be guarded against by every available means. 

Poisoning. — The effects of a fatal dose of phosphorus are not 
immediate. After a lapse of several hours great weakness occurs, 
accompanied in a large majority of cases by vomiting. Abdominal 
pains follow, the symptoms becoming more acute, mucus and bile 
being present in the ejecta, which for a while retain the odor and 
luminosity of phosphorus. With the cessation of vomiting pain 
is abated, although it may extend over the entire abdominal region 
and even be attended with paroxysms. 

The foregoing symptoms are accompanied by pronounced 
anorexia, thirst and fever, a thickly-coated or whitish tongue, 
burning in the throat, and often signs of collapse. The temper- 
ature at first reaches nearly the maximum possible without proving 
fatal, subsequently sinking below the normal. After a few days 
jaundice sets in. The urine is diminished, becoming charged with 
albumin and urates, and even bloody, containing among other 
ingredients biliary acids and coloring matter. In fatal cases urea 
is almost v/holly wanting. The stools may be normal, but the 
general condition is usually marked by diarrhea or constipation 
and flatulence. Hemorrhage often occurs, wounds bleeding pro- 
fusely, and as the severity of the symptoms increases delirium 
ensues, or coma terminating in convulsions. 

Serious nervous manifestations are frequently preceded by 
restlessness, insomnia, headache, and vertigo. In some delirious 
conditions wild, erotic states of the mind are the precursors of 
convulsive or comatose symptoms. Somnolence is not uncommon, 
with partial spasms and contraction or paresis of the voluntary 
muscles. Post-mortem examinations show that the liver, heart, 
kidneys, muscles, capillaries, and arterioles are implicated in the 
general effects of the poisoning, undergoing fatty degeneration. 

Sometimes the preponderating influence of the poison affects 



204 A TEXT-BOOK OF MATERIA MEDICA. 

the bronchial and gastro-intestinal mucous membranes, or it may 
visit the nervous system or be manifested in the circulatory sys- 
tem. In cases of acute poisoning the duration of the malady 
varies greatly, death occurring at times within a few days, or, again, 
being deferred for a few weeks. As a rule, recovery is retarded, 
the elimination of the drug requiring time. 

The symptoms of cJu'oitic poisoning are in some respects espe- 
cially marked, inhalation of phosphorus-fumes frequently resulting 
in pronounced conditions of necrosis, particularly of the lower max- 
illary, although it has been maintained that this feature of the poi- 
soning is contingent upon denuded surfaces of bone, disintegration 
or softening of tissues, caries of the teeth, or communicating wounds. 
Very rarely the palate and frontal bones are similarly attacked. 

Treatment of Poisoning. — Emetics and purgatives are of the 
first necessity. Copper sulphate is the most efficient emetic as well 
as the best chemical antidote. Hydrated magnesia, charcoal, and 
lime water have been suggested, yet their action is tardy, and a 
more efficient antidote is desirable. Several chemical and physio- 
logical agents have been employed to counteract the effects of the 
drug, among them old acid (oxygenated) oil of turpentine and 
potassium permanganate in a -|- per cent, solution, opium being 
used as a stimulant to the heart and the circulatory system. 

As prophylactic measures for the protection of workmen against 
phosphor-necrosis masks covering mouth and nose have been 
found serviceable, as well as inhalation of the vapor of turpentine 
obtained by suspending a small bottle of the fluid about the neck. 
The teeth should be kept constantly in good condition, since caries 
favors the tendency to necrosis. 

Therapeutics. — Phosphorus is not used externally, but inter- 
nally it is a food, especially of the nervous and osseous systems, 
stimulating protoplasmic activity, although, according to Gubler, 
" phosphorus is a rapid stimulant, but it acts by causing waste, and 
not by increasing power ; it impoverishes, and does not enrich ; 
it momentarily galvanizes, as it were, the torpid functions, but is 
incapable of renewing a dilapidated constitution or even a nervous 
system exhausted by chronic disease." 

Clinical experience has certainly demonstrated its utility as a 
nutrient tonic to the nervous and osseous tissues. In neurasthenia 
and chronic nervous exhaustion it is highly efficacious. Paraplegia, 
particularly when resulting from excessive venery, is usually bene- 
fited by this drug, while the cases of locomotor ataxia improved by 



HEM A TICS. 205 

phosphorus are numerous enough to deserve special consideration. 
Neuralgia, particularly of the fifth nerve and accompanied by great 
debility, is relieved by full doses administered every four hours. 

It is claimed by competent observers that certain cases of angina 
pectoris have been completely relieved by phosphorus. 

It has even been recommended in epilepsy, but its value here 
becomes more than doubtful when no mention of it is made by the 
best authorities on this disease. 

In paralysis resulting from cerebral hemorrhage it has been 
found beneficial. 

It has proved of great value in osteomalacia and rachitis, and 
the drug is credited with the cure of pernicious anemia, though it 
is singular, if the drug possesses any real value in this disease, that 
the fact has been recognized by so few observers. Such able men 
as Fox and Broadbent praise its efficacy in lymphadenoma. The 
insomnia of the aged and the ivakeftdness of cerebral anemia and 
exhaustion usually yield to this remedy. 

As to its aphrodisiac effects there is great difference of opinion, 
some physicians beheving it to be a most powerful agent in reliev- 
ing functional impotence, while others — among them so enthusiastic 
an advocate of phosphorus as Thompson — conclude that the drug 
is inefficient for this purpose unless given in larger doses than 
safety prescribes. The enthusiastic praise of its eulogists, however, 
as a remedy in impotence of a functional character is of so con- 
vincing a nature as to certainly justify an extended trial in this 
condition. Scarcely less is the testimony regarding its efficacy in 
chronic psoriasis, lepra, lupus, and acne indurata. 

Administration. — Since many persons have a peculiar suscepti- 
bility to phosphorus, its administration should begin with small 
doses, and, should it be thought necessary to prolong the adminis- 
tration for an indefinite period, the tendency of the drug to produce 
general steatosis should not be forgotten. 

The phosphorus pill is undoubtedly the best form in which to 
administer the drug, though it possesses the disadvantages of being 
insoluble in the intestinal fluids and of producing more or less 
irritation of the gastro-intestinal mucous membrane, though the 
latter effect is usually unnoticed under ordinary medicinal dosage 
on a full stomach. The liquid preparations of phosphorus are 
more unstable, tending to become rapidly inert by oxidation. 

The spirit of phosphorus is sometimes given in cod liver oil or 
the elixir of calisaya. 



206 A TEXT-BOOK OF MATERIA MEDICA. 

Calcii Hypophosphis— Calcii Hypophosphltis— Cal- 
cium Hypophosphite. U.S.I'. 

Origin. — Obtained by heating Phosphorus with Milk of Lime 
and exposing the mixture to the air. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or small, lustrous scales, or a white, crystalline 
powder ; odorless, having a nauseous, bitter taste, and permanent 
in the air. Soluble in 6.8 parts of water and in 6 parts of boiling 
water; insoluble in alcohol. 

Dose. — 5-6 grains (0.3-0.4 Gm.). 

Calcii Phosphas Prsecipitatus— Calcii Phosphatis 
Praecipitati— Precipitated Calcium Phosphate. 
77. s. r. 

Origin. — Prepared by the action of Hydrochloric Acid and 
Water upon Bone-ash, the addition of Solution of Ammonia to 
render the mixture of an alkaline reaction, and washing and drying 
the precipitate. 

Description and Properties. — A light, white, amorphous pow- 
der, odorless and tasteless, permanent in the air. Almost insoluble 
in cold water ; partly decomposed by boihng water, which dissolves 
out an acid salt; almost insoluble in acetic acid, except when 
freshly precipitated ; easily soluble in hydrochloric or nitric acid ; 
insoluble in alcohol. 

Dose. — 10-30 grains (o.6~2.0 Gm.). 

Sddii Hypophosphis— Sodii Hypophosphltis— 
Sodium Hypophosphite. TI, S. P. 

Origin. — Prepared by adding Sodium Carbonate to a solution 
of Calcium Hypophosphite and evaporating the filtrate. 

Description and Properties. — Small, colorless, transparent, rec- 
tangular plates of a pearly lustre, or a white, granular powder, 
odorless, and having a bitterish-sweet, sahne taste. Very deliques- 
cent on exposure to moist air. Soluble in i part of water and in 
30 parts of alcohol, also in 0.12 part of boiling water and in I part 
of boiling alcohol ; slightly soluble in absolute alcohol ; insoluble 
in ether. Sodium hypophosphite should be kept in well-stoppered 
bottles. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 



HE MA TICS. 207 

Potassii Hypophosphis— Potassii Hypophosphltis— 
Potassium Hypophosphite. TJ. S. I*. 

Origin. — Prepared in a similar manner to Calcium Hypophos- 
phite, or by double decomposition of Calcium Hypophosphite and 
Potassium Carbonate. 

Description and Properties. — White, opaque, hexagonal plates, 
or crystalline masses, or a granular powder, odorless, and having a 
pungent, saline taste ; very deliquescent. Soluble in 0.6 part of 
water and in 7.3 parts of alcohol. Potassium hypophosphite 
should be kept in well-stoppered bottles. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Acidum Hypophosphorosum Dilutum— Acidi Hypo- 
phosphorosi Diluti— Diluted Hypophosphorous 
Acid. U.S.JP. 

Orig-in. — Prepared by decomposing Potassium Hypophosphite 
by Sulphuric Acid, filtering, and evaporating to a syrupy consist- 
ence. It contains 10 per cent, by weight of absolute hypophos- 
phorous acid. 

Description and Properties. — A colorless liquid, without odor, 
and having an acid taste. Specific gravity about 1.046. Miscible 
in all proportions with water. 

Dose. — It is never used as a therapeutic agent by itself, but in 
the syrup of the hypophosphites. 

Syrupus Hypophosphitum— Syrupi Hypophosphi- 
tum— Syrup of Hypophosphites. 

Formula : Calcium Hypophosphite, 45 ; Sodium Hypophos- 
phite, 15; Potassium Hypophosphite, 15; Diluted Hypophos- 
phorous Acid, 2 ; Spirit of Lemon, 5 ; Sugar, 500 ; sufficient 
Water to make 1000. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 

Syrupus Hypophosphitum cum Ferro— Syrupi Hy- 
pophosphitum cum Ferro— Syrup of Hypophos- 
phites with Iron. 

Formula: Ferrous Lactate, 10; Potassium Citrate, 10; Syrup 
of the Hypophosphites, to 1000. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 



2o8 A TEXT-BOOK OF MATERIA MEDICA. 

Zinci Phosphidum— ZTnci Phosphidi— Zinc 
Phosphide. JJ. S. JP. 

Orig-in. — Prepared from Vapor of Phosphorus in a current of 
Dry Hydrogen over heated Zinc, after all atmospheric air has been 
expelled. 

Description and Properties. — A gritty powder of a dark-gray 
color, or crystalline fragments of a dark, metallic luster, and having 
a faint odor and taste of phosphorus. In contact with air it slowly 
emits phosphorous vapor. Insoluble in water or alcohol. Zinc 
phosphide should be kept in small glass-stoppered bottles. 

Dose. — yV"^ gi'sin (0.004-0.02 Gm.). 

Antag-onists and Incompatibles. — The sodium and potassium 
hypophosphites are incompatible with the soluble salts of mercury 
and silver, and the soluble phosphates and carbonates are incom- 
patible with calcium hypophosphite. Zinc phosphide is decom- 
posed by mineral acids. 

Synergists. — Phosphorus, cod liver oil, and the Restoratives 
generally. 

Physiological Action. — Although not possessing the active 
and poisonous properties of phosphorus, the hypophosphites are 
similar in their effect to small doses of phosphorus — i. e. in stimu- 
lating and regenerating the nervous system and those tissues 
which contain phosphorus and lime. 

The CALCIUM PHOSPHATE posscsscs no action superior to that of 
the hypophosphite, and its virtues are chiefly those of the hypo- 
phosphite. 

The phosphate is soluble to a slight extent in lactic and hydro- 
chloric acids, so that when taken by the stomach a portion diffuses 
into the blood. 

The ZINC PHOSPHIDE is more active, and resembles more closely 
the action of phosphorus, and in too large doses it irritates the 
stomach in the same manner as uncombined phosphorus. 

Therapeutics. — Externally and Locally. — The calcium phos- 
phate, combined with a little free phosphoric acid, has been 
recommended by Doubenski in the treatment of tuberculous ulcera- 
tions. ''Cold abscesses and fistulous tracts were treated by packing 
with gauze soaked with a solution of 5 parts to 100." 

Internally. — The hypophosphites may be employed for the same 
conditions as those in which phosphorus is used. In chloi^osis^ 
anemia, scrofula, and tuber ctdosis they have been highly recom- 
mended. In the author's opinion, in the cachexiae mentioned the 



HEM A TICS. 209 

benefit derived from their use is slight compared with that of cod 
Hver oil and the hygienic influences rendered serviceable in these 
conditions. 

The praise bestowed upon calcium phosphate consists largely 
of assertions rather than evidence : if it possesses any therapeutic 
value, it is chiefly that of the hypophosphite. 

The ZINC PHOSPHIDE has medicinal virtues greatly superior to 
those of the preparations above mentioned. In nervous disorders 
dependent upon defective nutrition it is equal, if not superior, to 
phosphorus, and it may be employed for any condition in which 
the latter drug is useful. 

Administration. — The zinc phosphide is best given in pill form. 
The hypophosphites and calcium phosphate may be given in cap- 
sules, though the syrup of the hypophosphites is usually preferred. 
It is a question whether the sugar which the syrup contains may 
not tend to induce or aggravate the gastric fermentation so often 
present in cases requiring the use of a reconstituent, 

Cinchona— Cinchonae— Cinchona. TJ. S. P. 

Origin. — The bark of Cinchona Calisaya Weddell, Cinchona 
officinalis L., and of their hybrids and those of other species 
of Cinchona, yielding, w^hen assayed by the process given in the 
U. S. Pharmacopoeia, *' not less than 5 per cent, of total alkaloids 
and at least 2.5 per cent, of quinine." The genus Cinchona 
as at present constituted consists of from thirty-one to thirty-six 
species, all of which are native to South America. The habitat 
of the tree follows the eastern slope of the Andes, beginning in 
Bolivia and extending through Peru. From about 2° south lati- 
tude in Ecuador it occupies also the eastern slope of the Western 
Cordilleras, until by two narrow belts it enters the highlands of 
New Granada, whence it spreads northeast and northward into 
Venezuela, reaching the vicinity of Caracas and the Caribbean 
Sea. 

The climate in which the most valuable species are found is, 
according to Karster (1858), characterized by a rainy season lasting 
for nine months, heavy rains falling principally during the night, 
alternating with sunshine and fog during the day. During the 
remaining three months of the year the nightly temperature fre- 
quently sinks below freezing-point, in the day-time, however, 
reaching 25° C. {jj"" F.), producing dense fogs. 

The Cinchonas are evergreen trees or shrubs, the most valuable 

14 



2IO A TEXT- BOOK OF MATERIA MEDIC A. 

species attaining a height of from 40 to 80 feet (12 to 24 M.). 
They are not met with in the valleys, but are found at altitudes 
varying from 330 feet (100 M.) to 11,500 feet (3500 M.). Accord- 
ing to Weddell, the most valuable species grow at an altitude of 
5300 to 7900 feet (1600 to 2400 M.). All the species are found 
in the primeval forests, either singly or in collections of a few 
specimens. The tree is cultivated in British Sikkin, Ceylon, Java, 
and Jamaica. 

Description and Properties. — In quills or in curved pieces, 
varying in length, and usually -^^ oi" \ ii^ch (2 or 3 Mm.), or some- 
times \ inch (5 Mm.), thick ; the outer surface covered with a gray 
or brownish-gray cork, usually slightly wrinkled, marked with 
transverse and also intersecting longitudinal fissures {C. Calisaya), 
and sometimes with scattered warts and slight longitudinal ridges ; 
inner surface light cinnamon-brown, very highly striate ; fracture 
of the outer layer short and granular, finely fibrous in the inner 
layer ; powder Hght- or yellowish-brown ; odor slight, somewhat 
aromatic ; taste bitter and somewhat astringent. 

Cinchona Rubra— Cinchonae Rubrae— Red Cin- 
chona. TI. S. JP. 

Origin. — The bark of Cinchona succirubra Pavor, containing not 
less than 5 per cent, of its peculiar alkaloids. 

Description and Properties. — In quills or in curved pieces, 
varying in length, and from -y^^^ \ ox \ inch (2 to 4 or 5 Mm.) 
thick ; the outer surface covered with a grayish-brown cork, more 
or less rough from warts and longitudinal warty ridges, and few, 
mostly short, transverse fissures ; inner surface more or less deep 
reddish-brown and distinctly striate ; fracture short-fibrous in the 
inner layer ; powder reddish brown ; odor slight ; taste bitter and 
astringent. 

Among the various alkaloids found in cinchona the following 
are the most important: Quinine, quinidine, michonine, and ciit- 
chonidine, the medicinal value of the bark depending almost exclu- 
sively upon the alkaloid quinine. 

Other less important ingredients are kinic and kinovic acids, 
kinovin, cinchotannic acid, cinchona-red, and a minute quantity of 
a butyraceous, volatile oil. The ash amounts to between i and 2 
per cent., consisting chiefly of the carbonates of calcium and potas- 
sium. 

Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.). 



HEMATICS. 211 

Official Preparations of CincJwna. 

Extractum Cinchonae — Extract! Cinchonae — Extract of Cinchona. — Dose, 5- 
30 grains (0.3-2.0 Gm.). 

ExtrSctum Cinchonae Fliiidum — ExtrScti Cinchonae Fliaidi — Fluid Extract 
of Cinchona. — Dose, 10-60 minims (0.6-4.0 Cc). 

Infusum Cinchdnae — Infusi Cinchdnae — Infusion of Cinchona (6 per cent.). — 
Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Tinctura Cinchonae — Tincturae Cinchonae — Tincture of Cinchona (20 per 
cent.). — Dose, 1-2 fluidrachms (4.0-8.0 Co.). 

Official Preparation of Cinchona Rubra. 

Tinctiira Cinchonae CompSsita — Tincturae Cinchonae CompSsitae — Com- 
pound Tincture of Cinchona (10 per cent., with Bitter Orange Peel 8 per cent., and 
Serpentaria 2 per cent.). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Official Alkaloids and Salts. 

Cinchonidinae Stilphas — Cinchonidinae Sulphatis — Cinchonidine Sulphate. 

— Description and Properties. — White, silky, acicular crystals, without odor and having 
a very bitter taste; slightly efflorescent on exposure to air. Soluble in 70 parts of water 
and in 66 parts of alcohol. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Cinchonina — Cinchoninae — Cinchonine . — Description and Properties. — White 
lustrous prisms or needles, without odor, at first almost tasteless, but soon developing 
a bitter after-taste; permanent in the air; soluble in 3760 parts of water and in 116 
parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Cinchoninae Stilphas — Cinchoninae Sulphatis — Cinchonine Sulphate. — 
Description and Properties. — Hard, white, lustrous, prismatic crystals, without odor 
and of a very bitter taste; permanent in the air; soluble in 66 parts of water and in 
10 parts of alcohol. 

Dose. — ^--Tf) grains (0.3-2.0 Gm.). 

Quinidinae Stilphas — Quinidinae Sulphatis — Quinidine Sulphate. — Descrip- 
tion and Properties. — White silky needles, odorless, and of a very bitter taste; per- 
manent in the air ; soluble in lOO parts of water and in 8 parts of alcohol. It should 
be kept in well-stoppered bottles, in a dark place. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Quinina — Quininae — Quinine. — Description and Properties. — A white, flaky, 
amorphous or crystalline powder, odorless, and having a very bitter taste ; permanent in 
the air; soluble in 1670 parts of water and in 6 parts of alcohol. Quinine should be 
kept in well-stoppered bottles, in a dark place. 

Dose. — 1-60 grains (0.06-4.0 Gm.). 

Quininae Bistilphas — Quininae Bisulphatis — Quinine Bisulphate. — Descrip- 
tion and Properties. — Colorless, transparent, or whitish orthorhombic crystals or small 
needles ; odorless and having a very bitter taste ; efflorescent on exposure to the air. 
Soluble in 10 parts of water and in 32 parts of alcohol. It should be kept in well- 
stoppered bottles, in a dark place. 

Dose. — 1-15 grains (0.06-1.O Gm.). 

Quininae Hydrobromas — Quininae Hydrobromatis — Quinine Hydrobro- 
mate. — Description and Properties. — White, light, silky needles; odorless and of a very 



212 A TEXT-BOOK OF MATERIA MEDICA. 

bitter taste. The salt is liable to lose water on exposure to warm or dry air. Soluble 
in 54 parts of water and in 0.6 part of alcohol. It should be kept in well-stoppered 
bottles, in a dark place. 

Dose. — 1-20 grains (0.06-1.3 Gm.). 

Quininae Hydrochldras — Quininae Hydrochloratis— Quinine Hydrochlorate. 
— Description and Properties. — White, silky, light, and fine needle-shaped crystals, 
odorless, and having a very bitter taste. The salt is liable to lose water on exposure to 
warm air. Soluble in 34 parts of water and in 3 parts of alcohol. Quinine hydro- 
chlorate should be kept in well-stoppered bottles, in a dark place. 

Dose. — 1-15 grains (0.06-1.0 Gm.). 

Quininae Stllphas — Quininae Sulphatis — Quinine Sulphate. — Description and 
Properties. — White, silky, light, and fine needle-shaped ciystals, fragile and somewhat 
flexible, making a very light and easily compressible mass, lusterless from superficial 
efflorescence after being for some time exposed to the air; odorless and having a per- 
sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to 
absorb moisture in damp air, and to become colored l)y exposure to light. Soluble in 
740 parts of water and in 65 parts of alcohol, also in 40 parts of glycerin and in about 
680 parts of chloroform, and freely soluble in dilute acids. It should be kept in well- 
stoppered bottles, in a dark place. 

Dose. — 1-60 grains (0.06-4.0 Gm.). 

Quininae Valerianas — Quininae Valerianatis — Quinine Valerianate. — 
Description and Properties. — White or nearly white, pearly, lustrous, triclinic crystals, 
having a sHght odor of valerianic acid, and a bitter taste; permanent in the air; soluble 
in 100 parts of water and in 5 parts of alcohol. It should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 1-20 grains (0.06-1.3 Gm.). 

Unofficial Alkaloids and Salts. 

Chinoidinum — Chinoidini — Chinoidine. — Origin. — Obtained from the mother- 
liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of 
cinchona. 

Description and Properties. — Cylindrical rolls or masses, of a more or less deep- 
brown or black color and a resin-like appearance. It has but a slight taste, being faintly 
bitter on mastication. Almost insoluble in water ; freely soluble in alcohol. 

Dose. — 3-30 grains (0.2-2.0 Gm.). 

Cinchonidinae Salicylas — Cinchonidinae Salicylatis — Cinchonidine Salicy- 
late. — Dose., 2-10 grains (0.12-0.6 Gm.). 

Cinchonina lodosiilphas — Cinchonmae lodosulphatis — Cinchonine lodosul- 
phate (Antiseptol) (50 per cent, of iodine). — Description and Properties. — A light 
powder of a reddish- brown color; insoluble in water, but soluble in alcohol. Used 
principally as a substitute for iodoform. 

Chinolin — Chinolin — Chinolin (Quinolin). — Origin. — Prepared from Cincho- 
nine or Quinine by distillation, or obtained synthetically. 

Description and Properties. — A colorless liquid, with an aromatic, pungent odor; 
slightly soluble in water, freely soluble in alcohol. 

Dose. — 3-10 minims (0.18-0.6 Cc). 

Chinolin TSrtras — Chinolin Tartratis — Chinolin Tartrate. — Soluble in 70 or 
80 parts of water. Dose, 5-15 grains (0.3-1.0 Gm.). 

Quinetum — Quineti — Quinetum. — A mixture of the alkaloids precipitated by an 
alkali. Dose, 1-60 grains (0.06-4.0 Gm.). 



HEMATICS. 213 

Quininse Hydrochloras Carbamidata — Quininae Hydrochloratis Carbami- 
datae. — Double salt of Quinine and Urea. Soluble in water. Dose, i-io grains (0.06- 
0.6 Gm.). Usually employed hypodennically. 



Antagonists and Incompatibles. — Agents promoting waste — 
such as the salts of mercury, iodine, copper, zinc, and lead — are 
therapeutically antagonistic to cinchona. The cerebral effects of 
quinine are antagonized by morphine, while atropine opposes its 
action upon the nervous and circulatory systems, as well as its 
antipyretic powers. 

The incompatibles are free tannic acid, alkalies and alkaline 
earths, and iodine. Fowler's solution is incompatible with infusion 
and decoction of cinchona. 

Synergists. — The Restoratives and all agents promoting con- 
structive metamorphosis. The antipyretic action of quinine is 
enhanced by the antipyretics, salicyhc acid, and some of the anti- 
septics. Its antiperiodic action is aided by arsenic, eucalyptus, 
carbolic acid, and creasote. 

The name Cinchona given to Peruvian bark was accorded in 
honor of the countess of Chinchon, cured of tertian fever by the 
use of the drug, as early as the seventeenth century, the Spanish 
conquerors of the country having discerned the curative properties 
of the plant which scientific investigation has rendered invaluable 
as a therapeutic agent. The native Indians had long been ac- 
quainted with its medicinal virtue, and but for the inquisitorial 
bigotry of the age the beneficiary of its potency, upon her 
return to Spain, would have introduced it into Europe. Such, 
however, was the antagonism aroused among an over-zealous 
clergy, and so great the force of professional rivalry, that every- 
where the new discovery encountered opposition, one religious 
body formally spurning it as the invention of unenlightened sav- 
ages, although the countess was not deterred from employing it 
among the peasantry dwelling upon her estates (Markham). 

About the middle of the seventeenth century a large quantity 
of the bark received from America reawakened discussion, and 
finally a council of Jesuits held at Rome approved a distribution 
of the drug — called therefrom " Jesuits' bark." It quickly found 
its way to other parts of the Continent and to England ; yet still 
the opposition to its use was pronounced, and it was only when an 
English quack doctor succeeded in effecting cures among persons 



214 A TEXT-BOOK OF MATERIA MEDIC A. 

of rank by an employment of the drug that its services became 
general in malarial and typhoid fevers, as well as in various other 
diseases. 

The discovery of the active principles of cinchona, crudely es- 
tablished by Duncan in 1803, was perfected by Pelletier and Cav- 
entou in 1820 by the preparations of quinine and cinchonine. In 
1833 quinidine became partially known, being completely isolated 
as an active principle in 1852, quinine and cinchonine having been 
employed since 1820-21. 

Until the researches of Marchiafava, Gelli, Laveran, Golgi, and 
others had disclosed the true etiology of malaria, quinine was used 
empirically in malarial diseases, its precise action being unknown. 
Its efficacy is now ascertained to be due to its power of destroying 
the Plasmodia of malaria. In addition to this action, which ren- 
ders the drug of the greatest value in malarial diseases, quinine 
possesses many other important properties, which are here con- 
sidered. 

Physiolog-ical Action. — Externally and Locally. — The drug is a 
potent antiseptic, preventing putrefaction and fermentation by its 
destructive influence upon fungi and infusoria, a solution of i : 250 
being sufficient for this purpose, while i : 500 is fatal to certain 
micro-organisms, and even so weak a solution as i : 1000 suffices 
to destroy some infusoria. 

Upon the unbroken skin it has little effect, other than to pro- 
duce occasionally a slight roughening of the surface. To raw 
surfaces, however, and to mucous membranes it is irritant. 

Internally. — Digestive System. — Its action resembles that of 
vegetable bitters, augmenting the secretions from the salivary and 
gastro-intestinal glands, stimulating peristalsis, and increasing the 
blood-supply to the stomach. Under moderate doses, therefore, 
the appetite and digestion are improved. Large dosage disturbs 
digestion, occasioning nausea, with, possibly, vomiting and diarrhea. 
The acidity of the stomach is said to be increased by quinine sul- 
phate. 

Circulatory System. — Small doses increase the force and fre- 
quency of the heart's action, excessive doses slowing and weaken- 
ing it, and, frequently in children, causing an intermittent pulse. 
Toxic doses paralyze the heart, arresting it in diastole. It is 
uncertain whether or not these effects are due to an action on 
the cardiac muscle or on the ganglia. It is evident, though, that 
small doses elevate and large doses depress arterial tension. 



HEMATICS. 215 

Quinine in a remarkable manner affects the constituents of the 
blood. The ameboid movements of the white blood-corpuscles 
are arrested, preventing their migration through the capillary walls 
in inflammation, while their number is diminished by full doses of 
the drug both in health and in inflammatory conditions. The red 
corpuscles are relatively increased in number, at least in propor- 
tion to the white corpuscles, the size of the former being dimin- 
ished in febrile conditions. 

Quinine retards or impairs all the oxidizing powers of the body, 
and materially lessens the oxygen-carrying capacity of the red 
corpuscles. This is shown in the diminished metabolism of the 
body. 

Nervous System. — Small doses stimulate the cerebrum. Large 
doses occasion cerebral congestion, with a sensation of dizziness, 
fulness in the head, and other symptoms described at length under 
" Cinchonism." 

The reflex function of the spinal cord is reduced, and under 
toxic doses ultimately abolished, owing to stimulation of Setsche- 
now's inhibitory center, and later to direct depression of the spinal 
cord and nerves. In frogs the sensory nerves are first excited and 
subsequently paralyzed, through the influence of the drug upon 
the peripheral endings. The muscles are uninfluenced, though 
when applied directly to muscular fiber the drug acts as an irritant, 
producing muscular contractions. 

Respiratory System. — Quinine exerts but little influence upon 
the respiration, small doses slightly increasing and large doses 
depressing the respiratory movements. 

Absorption and Elimination. — The drug is quite rapidly absorbed 
from the alimentary canal. While its presence may be detected 
in the urine within fifteen minutes after the ingestion of a full dose, 
many hours, or even days, may elapse before the drug is finally 
excreted. 

Much of the drug undergoes a change in the system, especially 
in the liver, yet it may be detected in the urine as quinine and 
various isomeric modifications of it. While chiefly eliminated 
by the kidneys, it may escape from the system by other channels, 
having been found in the milk, sweat, saliva, tears, bile, and in 
dropsical effusions. 

The excretion of uric acid, urea, and other nitrogenous material 
is considerably diminished under the use of quinine. 

Temperature. — In health the temperature is unaffected by qui- 



2l6 A TEXT-BOOK OF MATERIA MEDIC A. 

nine, but in febrile conditions, particularly in malarial fever, the 
drug acts as a powerful antipyretic. Yet the drug cannot be 
classed as a true antipyretic, since it has not been shown that it has 
any action on the heat-center. It is a matter of clinical observa- 
tion that intermittent, typhoid, and one form of puerperal fever are 
the only diseases which readily yield to the antipyretic influence of 
quinine, the temperature in such maladies as erysipelas, pneu- 
monia, pleurisy, etc. being comparatively unaffected even by large 
dosage, seeming to prove that the drug is an antipyretic only when 
it destroys or renders inert the infective agent producing the fever. 

Eye. — There have been recorded several cases of quinine amau- 
rosis, with transitory blindness, color-blindness, wide dilatation of 
pupils — irresponsive to light, but responding to accommodation 
effort — pallor of the optic disks, with extreme diminution of both 
retinal veins and arteries and contraction of the visual field. 

Quinine amaurosis, however, is probably very rare, but a lim- 
ited number of cases being recorded, although Rogers believes 
that "incomplete ocular cinchonism " is of quite frequent occur- 
rence. 

Uterus. — After the inception of labor quinine seems frequently 
to stimulate the uterine contractions. It also increases a scanty 
menstrual flow. There appears to be no authoritative evidence 
that quinine is an abortifacient. 

Untoward Action. — Besides the symptoms of cinchonism from 
which some persons suffer after the ingestion of a small dose, there 
are often occasioned various eruptions of the skin, often accom- 
panied by marked pruritus, the eruption produced by the drug at 
times strongly resembling scarlatina. 

Peculiar disturbances of vision and impaired hearing not infre- 
quently attend the administration of quinine. There have been 
recorded cases of renal and vesical irritation, varying in intensity, 
following the use of the drug. The administration of the salts of 
quinine in pill form is often followed by gastro-intestinal catarrh. 
The drug has also been known to occasion epistaxis and hem- 
optysis. 

Poisoning. — Excessive doses of quinine produce a series of 
symptoms collectively termed cinchonism. They are — a feeling of 
fulness in the head, ringing or buzzing in the ears, varying degrees 
of deafness, headache, with possibly delirium, disturbances of 
vision, vertigo, and muscular weakness. Should the dose be lethal, 
there may be marked cardiac and respiratory failure, and collapse. 



HEMATICS. 217 

Treatment of Poisoning. — Potassium bromide and hydrobromic 
acid are the best agents to relieve the symptoms of cinchonism, 
full doses of the latter given with quinine being said to prevent 
untoward results. 

Should the dose be sufficient to depress the heart and respira- 
tion in a marked degree, cardiac and respiratory stimulants would 
be indicated. 

Therapeutics. — Externally and Locally. — Powdered cinchona 
l^ark is an ingredient of many tooth-powders. Quinine also enters 
into the composition of many ** hair tonics," and is highly recom- 
mended by some physicians in the treatment of alopecia. 

The drug has been employed with varying success in many 
-diseases of the nose and throat, such as hay fever, zvhooping cough, 
.ozena, tonsillitis, etc. 

Ledetsch has highly recommended quinine bisulphate, i part to 
100 parts of water and glycerin, as an injection in gonorrhea. The 
•drug has been used with tincture of ferric chloride as a paint to 
prevent the spread of erysipelas. A 2 per cent, solution has proved 
an efficient remedy in cystitis, effectually preventing the decomposi- 
tion of the urine. 

Internally. — Undoubtedly the principal use of quinine is in the 
treatment of malarial diseases. When we realize that quinine in 
I part to 20,000 is destructive of the plasmodium malarias, it is 
readily understood why the drug should be so efficient as an 
antimalarial remedy. 

Quinine is one of the most powerful antiperiodics, being of 
more or less value in many diseased conditions characterized by 
periodical exacerbations. All forms of malarial fever usually yield 
to the proper use of quinine. It seems to be equally efficient as a 
prophylactic. 

Many periodical affections due occasionally to malarial organ- 
isms are peculiarly amenable to this drug, among these disorders 
being various neuralgias, headache, asthma, hay fever, chorea, jaun- 
dice, diarrhea, dysentery, etc. 

Quinine is a potent antiphlogistic, being very efficient in check- 
ing inflammation and suppuration. It is particularly beneficial in 
•cases of prolonged suppuration, such as ptdmonary phthisis , fistu- 
lous discharges, septicemia, pyemia, puerperal fever, etc. It favor- 
ably influences the formative stages of acute inflammations, as in 
the beginning of endocarditis, pneumonia, pleurisy, etc. 

As a tonic or restorative during the course of febrile diseases, 



2l8 A TEXT-BOOK OF MATERIA MEDICA. 

as well as in convalescence, quinine is highly efficient. Its action 
upon the gastro-intestinal tract renders it valuable in many forms 
of dyspepsia, especially the atonic variety. In these cases, where 
anemia is present, the drug may be advantageously combined with 
iron and nux vomica. 

Quinine is but. little used now as a pure antipyretic, being of 
value in this respect, as previously stated, only when it destroys 
the infective cause of the fever. Its antipyretic influence is conse- 
quently more marked in intennittent fever. It is of value also in 
typJwid, although now seldom employed in this disease. 

The remedy has proved efficient in some cases of chorea and 
whooping cough. It is of decided value in the yeas /y vomiting -pro- 
duced by the sarcina ventriculi, and equally beneficial in impetigo ; 
while acne and ecthyma, when occasioned by reduced vitality and 
impaired nutrition, are greatly benefited by its internal use. 

Quinine is serviceable in stimulating the uterine contractions 
during labor and increasing the menstrual discharge in amenorrhea. 

Contraindications. — The drug is contraindicated in acute in- 
flammations of the genito-urinary and gastro-intestinal tracts, in 
acute or subacute inflammations of the middle ear, and in menin- 
gitis and cerebritis. It should not be given to infants suffering 
from eczema, nor to persons having a marked idiosyncrasy against 
the drug. 

Administration. — Because of its intensely bitter and disagree- 
able taste quinine should not be given in solution. It may be sus- 
pended in syrup of yerba santa or in the aromatic elixir of liquorice,, 
which disguises the taste quite effectually, and for children is pref- 
erable, as a method of administration, to capsules or pills. In the 
case of adults the drug should be given in gelatin capsules or in 
the form of gelatin- or sugar-coated pills. 

The tannate of quinine is comparatively tasteless, and may be 
incorporated with chocolate in the form of lozenges, thus being 
readily taken by children. 

The drug may be also administered in a suppository by the 
rectum or incorporated in lard and rubbed into the skin, preferably 
in the axillae and the inner side of the thighs or over the abdomen. 
It has been employed to some extent hypodermically, the quinine 
hydrobromate and hydrochlorate being the salts preferred for this 
purpose. Injections should be made in the buttocks, and very 
slowly administered, since this method of administration depresses 
the heart to a considerable degree. 



ANIMAL EXTRACTS. 219 

Occasionally in the treatment of malaria Warburg's tincture, 
containing numerous aromatics, is more efficient than quinine. 

In obstinate malarial affections aromatics and spices greatly 
enhance the effect of quinine, capsicum making one of the best 
adjuvants. The portal circulation is stimulated, rendering the 
absorption of the drug more rapid and its effects more lasting. 

As to the time and method of administration in malarial dis- 
eases, the student is referred to any standard work on the Practice 
of Medicine. 

The various tinctures and elixirs of cinchona are used exten-- 
sively; when employed as stomachics they should be given before 
meals. 

Quinine is best given on an empty stomach or after the active 
process of digestion is completed. 



ANIMAL EXTRACTS (ORGANOTHERAPY). 

The striking fact that various excretions and tissues of the 
living organism, when administered under certain conditions, possess 
a peculiar therapeutic value is now well established. The theory 
has long been the subject of studious attention, yet the practical 
application of organotherapy has in recent years acquired unprece- 
dented importance. Extracts derived from almost every portion of 
the human system, together with many animal secretions, have been 
prepared, one of the most original being the hypodermic injection 
of an extract from the recent testicles of mammals adopted by 
Brown-Sequard in 1889 in the treatment of senile debility. As a 
nutrient restorative spermini hydrochloras was found to be an 
efficacious remedy, abundant evidence showing that the functional 
activity of deteriorating organs of the animal economy was per- 
ceptibly improved, the nervous system responding favorably to the 
influence of the new agent. Cancer and chorea are said to have 
also been benefited by spermine. 

Subsequently neurasthenia, locomotor ataxia, and declining 
nervous force due to old age were successfully treated with a 
glycerin extract from the gray matter of a sheep's brain, the pro- 
cedure, as suggested by Paul, consisting of a nervous transfusion 
by hypodermic injection. 

The most rational and successful application of organotherapy, 
however, was that of Murray in 1891, who proposed the subcir- 



220 A TEXT-BOOK OF MATERIA MEDICA. 

taneous injection of a th37Toid extract in the treatment oi myxedema, 
many cases of which have amehorated, while others have been 
definitely cured, by the adoption of the remedy. The preparations 
•in this case have included the ingestion of the dry powder, the 
injection of a glycerin extract, and the raw or partially cooked 
gland administered as food. The general testimony of writers 
amply attests the efficacy of the remedy, which now receives 
almost universal acceptance. 

Baumann has recently isolated from the thyroid glands of sheep 
an organic compound which he beheves to be the essential prin- 
ciple of the gland and the efficient agent in the treatment of 
various forms of myxedema. Clinical observations by Ewald, Ross, 
and Treufel seem to prove the correctness of Baumann's opinion. 

In exophthalmic goiter the employment of thyroid gland has 
been held to be favorable, although authorities are not wanting 
who claim that its use tends to aggravate the symptoms. 

Especially interesting are the results of thyroid treatment in 
cretinism of infants — infantile mj/xede7na—3.uihcntic reports offer- 
ing highly encouraging details of its successful application in this 
disease, eliciting from Sinkler the declaration : ** It is too short a 
time since the introduction of the thyroid-feeding in cretinism to 
form any opinion as to the final results ; but since in all the cases 
reported remarkable changes have taken place, we have reason to 
rejoice in possessing a remedy which can accomplish so much as 
has already been done in these once worse than hopeless cases." 

It is to be observed that both the endemic and sporadic forms of 
the above malady have proved amenable to the thyroid treatment. 

Jackson concludes that " in myxedema and cretinism it is worth 
while to run a risk as to life in the hope of removing symptoms 
that make life hardly worth living. In dermatoses, on the con- 
trary, life is generally little endangered, and we are not justified in 
resorting to too heroic measures." 

The remedy has been applied in insanity, with the effect of im- 
proving depressed, but intensifying maniacal, conditions, care being 
requisite in the presence of certain contraindications, such as 
tuberculosis, valvular disease of the heart, etc. 

Bramwell reports a case of tetanus resulting from thyroid extir- 
pation cured by doses of the gland ; another of idiopathic tetany 
yielding to the same treatment. 

With regard to thyroid treatment in skin diseases, Abraham 
asserts that there is no constant effect in psoriasis and many other 



ANIMAL EXTRACTS. 221 

cutaneous affections, and that in a large number of cases the results 
are negative, and that untoward effects are alarmingly frequent. 

Improvement has been noted in several cases of malignant 
syphilis, Menzies considering that thyroid acts as a powerful skin- 
tonic and a useful adjuvant to mercury and potassium iodide in the 
treatment of this disease. 

With regard to thyroid, however, it must be admitted that, save 
in myxedema, simple goiter, and obesity, the remedy is of com- 
paratively slight value, and even in these affections only by con- 
tinued treatment have favorable results been obtained. 

The favorable results often attending the partial employment of 
animal agents in diseases of corresponding organs, and especially 
the noteworthy benefits derived from the application of the thyroid 
treatment in myxedema, have suggested the preparation of many 
extracts of varying efficacy. Among these are — 

Nuclein. — In 1894, Professor V. Vaughan, of the University of 
Michigan, read a paper before the Illinois State Medical Associa- 
tion, giving the results of numerous experiments made by himself 
and Dr. McClintock with nuclein. 

Nuclein is a complex proteid body, characterized by its large 
percentage of phosphorus. It is that constituent of a cell by vir- 
tue of which the histologic unit grows, develops, and reproduces 
itself; it is the function of the nuclein to utilize the pabulum within 
its reach ; it is by the action of their nuclein that cells of various 
organs and organisms possess and manifest their individual charac- 
teristics. It is sometimes called chromatin on account of the readi- 
ness with which it absorbs and holds coloring-agents. The chro- 
matic difference in the nucleins of various cells is an aid to their 
identification under the microscope. 

The phosphorus exists in the form of nucleinic acid ; so far as 
is known, this acid is the same in all cells, yet the basic part differs 
in various nucleins. Most of the experiments of Vaughan and 
McClintock, as well as those of nearly all others, have been made 
with the yeast nuclein ; that cell is particularly rich in nucleinic 
acid, easily obtained free from contamination. 

When administered hypodermatically or orally, nuclein increases 
the number of leukocytes in about three hours. The amount of 
increase varies with the subject ; it may be slight or it may be three- 
fold ; it occurs principally in the polynuclear cells. Metschnikoff 
has shown that these cells are the most active of the phagocytes. 

Hans Buchner has demonstrated that the blood-serum, freed from 



222 A TEXT-BOOK OF MATERIA MEDICA. 

■corpuscular elements, is bactericidal. This bactericidal potency is 
due to nuclein, found free in the blood and probably secreted by 
the leukocytes. Hahn of Munich has made experiments with se- 
rum upon the staphylococcus pyogenes aureus and the bacillus 
coli communis, showing that the administration of yeast nuclein 
•increased this germicidal power several fold. The effects of nu- 
clein pass away in about forty-eight hours. 

Nuclein is of great value in conditions of infection where the 
symptoms are due to general invasion of the bacteria. Favorable 
results are obtained in simple anemias. It is found on the market 
in a 5 per cent, solution, dose i to 2 drachms. It should be given 
on an empty stomach. Vaughan reports that in tuberculosis the 
effect of moderate injections has been to lower the temperature, 
without untoward manifestations. Indolent ulcer has yielded com- 
pletely to a similar treatment. 

It is also stated upon high authority that the remedy is useful 
in " all forms of anemia, in chronic and recurrent malaria, in diges- 
tive disorders, and in acute and chronic pulmonary affections " 
(Aulde), the nuclein adopted being obtained from the thyroid and 
thymus glands. The latter author suggests the use of nuclein in 
the treatment of typhoid^ in which disease the activity of leucocy- 
tosis is defective. 

Bone-marrow has proved efficacious in anemia (Dickson, 
Frazer), and has also been employed by Filleau in tuberculosis. 

Brain-extract, besides its utility in locomotor ataxia and se7tile 
debility, has been reported as beneficial in certain organic and func- 
tional diseases of the nervous system — in epilepsy, hysteria, mi- 
graine, hebephrenia, etc., as well as in bulbar palsy and general 
paralysis of the insane. 

Heart-extract has been recommended in cases of nervous 
prostration, it being claimed that its action tends to raise the 
blood-pressure and increase the number of red corpuscles ; 
rauscle-extract has served a useful purpose in affections of the 
corresponding tissues ; extract of pancreas, though with small 
success, has been employed in diabetes mellitus ; and among other 
preparations used with doubtful or auspicious results are meduUin, 
from the cord ; renin, from the kidneys ; gastrin, from the stom- 
ach ; and ovarin, from the ovaries. 

The subject is fraught with interest to the clinician, and, as in 
serum-therapy, the rapid progress of therapeutic knowledge bids 
fair to extend its value in the rational treatment of human disease. 



DIVISION II.— SPECIFICS. . 



These drugs are unnatural to the system, though acting spe- 
cifically, and in some unknown way, against certain diseases or 
morbid conditions. They are given with a view to influencing the 
course of the disease itself, not for their effect upon the symptoms 
alone. If administered for any length of time, there is danger of 
causing an artificial disease, because of the characteristic action of 
these medicines, which differs essentially from their remedial influence. 

When used as specifics they do not produce or relieve symp- 
toms, except by renewal of health or by removing either the 
pathological condition or the disease. Whenever, therefore, these 
drugs produce symptoms when used specifically, it is a sign that 
they are contraindicated, or have been given for too long a time, 
-or in too large doses. As they are unnatural, and consequently 
more or less poisonous to the system, their administration should 
be accompanied by restoratives to lessen their tendency to unto- 
ward manifestations and systemic depression. 

Mercury, being perhaps the most typical specific, will be first 
considered. 

Hydrarg-yrum—Hydrargyri— Mercury. U. S, P. 

(QuiCKSn.VER.) 

Origin. — The knowledge of this drug antedates the Christian 
•era. It is found in Spain, Austria, Peru, and China, but is obtained 
principally from New Almaden, California. It occurs to some ex- 
tent in the metallic state in the form of minute or large globules ; 
also in combination with oxygen, chlorine, selenium, etc. ; but the 
principal ore from which it is extracted is cinnabar. 

Description and Properties. — A shining, silver-white metal, 
without odor or taste. It is liquid at the ordinary temperature, 
and easily divisible into spherical globules ; but when cooled to 
— 39-38° C. ( — 38.88° F.), it forms a ductile, malleable mass. 
Specific gravity, 13.5584 at 15° C. (59° F.). 

Insoluble in the ordinary solvents, also in concentrated hydro- 
chloric acid, and, at common temperatures, in sulphuric acid, but 
dissolving in the latter when boiled with it, and readily and com- 
pletely soluble in nitric acid. Mercury should be kept in strong, 
well-stoppered bottles. 

223 



224 A TEXT-BOOK OF MATERIA MEDIC A. 

Dose. — Mercury is seldom given internally except in the modi- 
fied form of blue pill. 

Hydrargyrum Ammoniatum— Hydrargyri Ammo- 
niati— Ammoniated Mercury. U.S.JP. 

Origin. — Prepared by mixing solutions of Ammonia and Cor- 
rosive Mercuric Chloride. Filter and wash the precipitated am- 
moniated mercury. 

Description and Properties. — White, pulverulent pieces, or 
white, amorphous powder, without odor, and having an earthy, 
and afterward styptic and metallic taste. Permanent in the air. 
Almost insoluble in water or in alcohol. It should be kept in well- 
stoppered bottles, protected from the light. Used externally. 

Official Prepai^ation. 

UnguSntum Hydrargyri Ammoniati — UnguSnti Hydrargyri Ammoniati — 
Ointment of Ammoniated Mercury. — Formula: Ammoniated Mercury, lo; Ben- 
zoinated Lard, 90 parts. For external use. 

Hydrargyrum cum Creta— Hydrargyri cum Greta- 
Mercury with Chalk. V. S. J>. 

Origin. — Obtained by trituration of Mercury, Prepared Chalk, 
Clarified Honey, and Water. 

Description and Properties. — A light gray, rather damp pow- 
der, free from grittiness, without odor, and having a slightly sweet- 
ish taste. It contains 38 per cent, of mercury. This preparation 
should be kept in well-stoppered bottles, protected from light. 

Dose. — 3-10 grains (0.18-0.6 Gm.). 

Massa Hydrargyri— Massae Hydrargyri— Mass of 
Mercury. U. S. JR. 

(PiLULA Hydrargyri— Blue Mass — Blue Pill.) 
Composed of Mercury, Glycyrrhiza, Althaea, Glycerin, and 
Honey of Rose. 

Dose. — i-io grains (0.03-0.6 Gm.). 

Unguentum Hydrargyri — Unguenti Hydrargyri — 
Mercurial Ointment. U. S, JP. 

(Blue Ointment.) 
Composition : Mercury, Lard, Suet, and Oleate of Mercuiy. 
Used externally. 



SPECIFICS. 225 

Emplastrum Ammoniaci cum Hydrargyro — Em- 
plastrum (ace.) Ammoniaci cum Hydrargyro— 
Ammoniac Plaster with Mercury. TJ. S. I". 

Composition : Ammoniac, Mercury, Oleate of Mercury, Diluted 
Acetic Acid, and Lead Plaster. Used externally. 

Emplastrum Hydrargyri— Emplastri Hydrargyri— 
Mercurial Plaster. JJ. S. P. 

Composition : Mercury, Oleate of Mercury, and Lead Plaster. 
Used externally. 

Hydrargyri Chloridum Corroslvum — Hydrargyri 
Chloridi Corrosivi— Corrosive Mercuric Chloride. 
U. S. 1>. 

(Corrosive Chloride of Mercury — Corrosive Sublimate.) 

Origin. — Prepared by heating a mixture of Mercuric Sulphate, 
Sodium Chlorate, and Manganese Dioxide. The corrosive chloride 
sublimes and is condensed. 

Description and Properties. — Heavy, colorless, rhombic crys- 
tals or crystalline masses ; odorless and having an acrid and per- 
sistent metallic taste. Permanent in the air. Soluble in 16 parts 
of water, in 3 parts of alcohol, in 2 parts of boiling water, in 1.2 
parts of boiling alcohol, in 4 parts of ether, and in about 14 parts 
of glycerin. It should be kept in well-stoppered bottles. 

Dose. — -g^-J grain (0.001-0.008 Gm.). 

Hydrargyri Chloridum Mite — Hydrargyri Chl5ridi 
MItis— Mild Mercurous Chloride. U. S. r. 

(Calomel — Mild Chloride of Mercury.) 

Origin. — Obtained by triturating Mercuric Sulphate, Mercury, 
Sodium Chloride, and boiling Distilled Water. Sublime, and wash 
the sublimed calomel with boiling distilled water. 

Description and Properties. — A white, impalpable powder, be- 
coming yellowish-white on being triturated with strong pressure. 
It is odorless and tasteless, and permanent in the air. Insoluble in 
water, alcohol, or ether, and also in cold, diluted acids. When 
strongly heated it is wholly volatilized, without melting. Calomel 
should be kept in dark, amber-colored bottles. 

Dose. — -3^2~io grains (0.002-0.6 Gm.). 

Calomel enters into the following 

15 



226 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 

Pilulae Antimonii Comp6sitae — Pilulas (ace.) Antimonii Comp6sitas— Com- 
pound Pills of Antimony. — Dose, i or 2 pills. 

Pilulse Catharticae CompSsitae — Pilulas (ace.) Catharticas Comp6sitas — 
Compound Cathartic Pills. — Dose, i to 3 pills. 

Hydrargryri Cyanidum— Hydrargryri Cyanidi— Mer- 
curic Cyanide. TJ. S, I*. 

Orig-in. — It may be obtained by boiling pure Ferrocyanide of 
Iron with Mercuric Oxide ; the mercuric cyanide, entering into 
solution, is separated by filtration, evaporization, and ciystallization 
from diluted alcohol. 

Description and Properties. — Colorless or white prismatic 
crystals ; odorless, and having a bitter, metallic taste {the salt is 
exceedi?igly poisonous^, becoming dark-colored on exposure to 
light. Soluble in 12.8 parts of water and in 15 parts of alcohol. 

Dose. — rio~rB" gi'^i" (0.0006-0.004 Gm.). 

Hydrarg-yri I5didum Flavum— Hydrargyri lodidi 
Flavi— Yellow Mercurous Iodide. U.S. P. 

(Hydrargyri Iodidum Viride — Protiodide of Mercury — Yellow (or Green) 

Iodide of Mercury.) 

Origin. — Prepared by mixing solutions of Potassium Iodide 
and Mercurous Nitrate with Nitric Acid and Distilled Water. 
The precipitate is washed and dried. 

Description and Properties. — A bright yellow amorphous 
powder, odorless and tasteless. By exposure to light it becomes 
darker in proportion as it undergoes decomposition into metallic 
mercury and mercuric iodide. Almost insoluble in water, and 
wholly insoluble in alcohol or ether. It should be kept in dark, 
amber-colored vials, with the least possible exposure to Hght. 

Dose. — \—^ grain (0.01-0.03 Gm.). 

Hydrarg-yri Iodidum Rubrum- Hydrargyri lodidi 
Rubri— Red Mercuric Iodide. U. S. JP. 

(BiNiODiDE OF Mercury — Red Iodide of Mercury.) 

Origin. — Prepared by mixing solutions of Corrosive Mercuric 
Chloride and Potassium Iodide ; filter, and dry the precipitated red 
iodide. 

Description and Properties. — A scarlet-red, amorphous pow- 
der, odorless and tasteless ; permanent in the air. Almost insoluble 



SPECIFICS. 227 

in water, but soluble in 1 30 parts of alcohol. It should be kept in 
well-stoppered bottles, protected from light 

Dose. — 3V-1V grain (0.002-0.004 Gm.). 

This drug enters into the 

Official Preparation. 

Liquor Arseni et HydrSrgyri lodidi — Liquoris Arseni et HydrSrgyri lodidi 
— Solution of Arsenic and Mercuric Iodide. — (Described under Arsenic.) — Dose, 
5 minims (0.3 Cc), gradually increased. 

Hydrargyri Oxidum Flavum— Hydrargyri Oxidi 
Flavi— Yellow Mercuric Oxide. TJ. S. JP. 

Origin. — Prepared by precipitating a solution of Corrosive 
Mercuric Chloride with Soda. 

Description and Properties. — A light orange-yellow, amor- 
phous, heavy, impalpable powder ; odorless, and having a some- 
what metallic taste. Permanent in the air, but turning darker on 
exposure to light. Almost insoluble in water or in alcohol. It 
should be kept in well-stoppered bottles, protected from light. 
Not used internally. 

Official Preparation. 

UnguSntum Hydrargyri Oxidi Flavi — UnguSnti HydrSrgyri Oxidi Flavi — 
Ointment of Yellow Mercuric Oxide. — Formula: Yellow Mercuric Oxide, 10; 
Ointment, 90 parts. Used externally. 

Hydrargyri Oxidum Rubrum— Hydrargyri Oxidi 
Rubri— Red Mercuric Oxide. TI. S. I". 

(Red Precipitate.) 

Origin. — ^^Prepared by dissolving Mercury in Diluted Nitric 
Acid. Evaporate to dryness. Triturate the mercuric nitrate thus 
formed with mercury and heat. 

Description and Properties. — Heavy, orange-red crystalline 
scales, or a crystalline powder, becoming yellower the finer it is 
divided ; odorless, and having a somewhat metallic taste ; perma- 
nent in the air. Almost insoluble in water and in alcohol. It 
should be kept in well-stoppered bottles, protected from light. 

Dose. — oVtV gi'^in (0.001-0.006 Gm.). 

Official Preparation. 
UnguSntum Hydrargyri Oxidi Rubri — UnguSnti Hydrargyri Oxidi Rubri 
— Ointment of Red Mercuric Oxide. — Formula: Red Mercuric Oxide, 10; Castor 
Oil, 5; Ointment, 85 parts. Used externally. 



228 A TEXT-BOOK OF MATERIA MEDIC A. 

Hydrargryri Subsulphas Flavus— Hydrargyri Sub- 
sulphatis Flavi— Yellow Mercuric Subsulphate. 
77. >S^. ^. 

(Basic Mercuric Sulphate — Turpeth Mineral.) 

Orig-in. — Obtained by dissolving Mercury in Sulphuric and 
Nitric Acids. Add a sufficient quantity of Water. Decant and 
dry the residue. 

Description and Properties. — A heavy, lemon-yellow powder, 
odorless and almost tasteless ; permanent in the air. Soluble in 
about 2000 parts of water. Insoluble in alcohol. It should be 
kept in well-stoppered bottles, protected from the light. 

Dose. — i-3 grains (0.015-0.18 Gm.). 

Liquor Hydrargyri Nitratis— Liqu5ris Hydrargyri 
Nitratis— Solution of Mercuric Nitrate. V. S. I*. 

A liquid containing about 60 per cent, of Mercuric Nitrate, 
together with about 1 1 per cent, of free Nitric Acid. 

Description and Properties. — A clear, nearly colorless, heavy 
liquid, having a faint odor of nitric acid and a strongly acid reac- 
tion. The product should be kept in glass-stoppered bottles. 

Used externally as a caustic. 



Unguentum Hydrargyri Nitratis — Unguenti Hy- 
drargyri Nitratis— Ointment of Mercuric Nitrate. 
U. S. JP. 

(Citrine Ointment.) 

Formula: Mercury, 70; Nitric Acid, 157; Lard Oil, 760 parts. 
Used externally. 

Unofficial Preparations. 

Hydrargyri Salicylas — Hydrargyri Salicylatis — Mercurous Salicylate. — 

Dose of Mercurous Salicylate, \-\ grain (0.00S-0.015 Gm.). — Dose of Mercuric Salicy- 
late, yL-i grain (0.004-0.008 Gm.). 

HydrSrgyri Formamidatum — HydrSrgyri Formamidati — Formaniidate of 
Mercury. — Dose for hypoder7nic use, yV-J grain (0.005-0.01 Gm.). 

Hydrargyri T^nnas — HydrSrgyri Tannatis — Mercurous Tannate. — Dosey 
i-l grain (0.03-0.06 Gm.). 

Lotio Flava — Lotionis Flavae — Yellow Wash. — Corrosive Sublimate, 25 grains 
(1.5 Gm.), in Lime Water, 16 ounces (473.17 Cc). For external use. 

Ldtio Nigra — Lotionis Nigrae — Black Wash. — Calomel, 64 grains (4.15 Gm.)^ 
in Lime Water, 16 ounces (473.17 Cc). For external use. 

Asparagin Hydrargyrate. — Dose, \ grain (0,01 Gm.), hypodermically. 



SPECIFICS. 229 

Antagonists and Incompatibles. — Mercury with chalk is in- 
compatible with acids and acidulous salts. Calomel is incompatible 
wi-th alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, 
iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, 
as well as hydrochloric acid, potassium, ammonium, and sodium 
chloride. 

Corrosive subhmate is incompatible with alkalies and their car- 
bonates, soap, lime water, tartar emetic, the iodides of potassium 
and sodium, acetate of lead, silver nitrate, the sulphides, albuminous 
liquids (as milk, etc.), many vegetable infusions, and compound 
syrup of sarsaparilla. 

In general, metallic preparations of mercury are incompatible 
with iodine and the chlorides. 

Synergists. — Potassium iodide enhances the antisyphilitic action 
of mercury. Depressants — such as antimony and alkalies — increase 
the physiological activity of mercury and its preparations. 

Tonic and resin-bearing purgatives — such as aloes, rhubarb, 
and podophyllum — aid the cathartic action of some of the mercurial 
preparations. 

Physiological Action. — Externally and Locally. — Liquid metal- 
lic mercury is inert. Most of the preparations applied to the skin 
are antiparasitic and antiseptic, corrosive mercuric chloride being 
one of the most important antiseptics and universal germicides 
known. 

Some of the mercurials are powerful irritants, the nitrate being 
an active caustic. The mercurous salts, even, possess slightly 
stimulating properties. 

Metallic mercury and its salts are readily absorbed with the aid 
of friction, at times producing a slight irritation resulting from their 
stimulating properties. Absorption may also take place from local 
application in the form of a fine vapor. 

The introduction of the drug into the system through the 
medium of the skin is attended with all the symptoms of mercurial 
poisoning. The local actions of the various preparations differ 
somewhat, yet they agree in certain physiological effects produced 
after absorption of the drug. 

A common feature of mercurial application is a slight, peculiar 
fetor in the mouth, accompanied by soreness of the teeth, swelling 
of the gums, and an increase of saliva, ptyalism being a marked 
symptom of mercurial disturbance. A disagreeable metallic taste 
is seldom absent. These symptoms assume a serious phase if the 



230 A TEXT-BOOK OF MATERIA MEDIC A. 

application be continued, stomatitis and other graver conditions 
ensuing. 

Internally. — Digestive System. — Small doses have little untoward 
effect ; they may even prove tonic. Large doses act unfavorably 
upon the gastro-intestinal mucous membrane, causing diarrhea and 
possibly more serious derangement. As purgatives the mercurial 
preparations act by augmenting the secretions of the intestinal 
glands ; at the same time the pancreatic secretions are increased 
and there is marked activity of the absorbent system. The prin- 
cipal action is on the duodenum, hastening evacuation of the bile 
and preventing its reabsorption. While promoting excretion of 
bile, they act the reverse as to its secretion. This is particularly 
true of calomel, which actually diminishes that secretion, though 
it is alleged that the corrosive mercuric chloride is a direct chola- 
gogue, stimulating to some extent the hepatic secretory apparatus. 

Circulatory System. — Corrosive sublimate exerts a decided in- 
fluence upon the heart, its toxic effect tending to diminish cardiac 
action. The remaining preparations of mercury appear to be less 
active in this respect. The physical action of the drug upon the 
corpuscular constituents of the blood has been well ascertained, 
anemia, reduced cohesion, and final dissolution having been ob- 
served. It is to be noted that under prolonged or over-dosage 
the blood becomes impoverished, its ozonizing function is impaired, 
and the fibrin loses its coagulability. But when administered in 
minute doses the mercuric corrosive chloride acts as a tonic to the 
blood, increasing the number of red corpuscles and the body- 
weight. 

Should " tonic doses " be continued for too long a period, there 
would be increased weight, owing to too great stimulation of the 
lymphatic system. 

Nervous System. — The full effects of mercury and its prepara- 
tions upon the nervous system are best seen when toxic doses 
are given. The effects are considered in extenso under the head 
of " Poisoning." 

Respiratory System. — The general tendency of mercury, in those 
who have been subject to prolonged dosage, is to depress the cir- 
culation, rendering the breathing labored and debilitated, a sense 
of respiratory constriction being present. 

Absorption and Elimination. — When a preparation of mercury 
is taken internally it is converted in the stomach into a double 
chloride of sodium and mercury. This substance, uniting with the 



SPECIFICS. 231 

albuminous juices, is soluble in an excess of albumin and sodium 
chloride, and, readily diffusing into the blood, is converted into, 
and exists in that fluid as, the oxyalbuminate of mercury. 

The absorption of this drug is gradual, yet, notwithstanding 
every secretion of the body contributes to its general expulsion 
from the system, its cumulative action is a well-established fact. 
Elimination occurs chiefly by the urine, the saliva, bile, sweat, milk, 
and feces. Even the semen shares in the process. Single doses 
may be eliminated in twenty-four hours, but the drug has been 
detected in the liver a year after the discontinuance of prolonged 
treatment. 

Mercury has been found in serum and in pus from ulcers. 

Calomel possesses marked diuretic action, greatly increasing the 
amount of urine. 

Temperature. — Save in a secondary manner, temperature is sel- 
dom affected. From over-stimulation or irritation the drug may 
produce local inflammatory conditions or even febrile symptoms. 

Eye. — Himly mentions that amaurosis meramalis occurs in 
workers in mercury, w^hile Galezowski reports an example of optic 
atrophy, and Square cites a case of optic neuritis, due to the toxic 
action of mercurial salts. 

Untoward Action. — Many affections of the skin manifest them- 
selves after the exhibition of mercury, erytJiema and ecze^na (eczema 
mercuriale) frequently occurring after either the ingestion or the 
external application of mercurial preparations. 

The author recalls one patient in whom \ grain {0.016 Gm.) of 
calomel excited an exanthematous eruption over the entire body, 
some edema of the face, together with fever and angina of the 
fauces. At another time similar symptoms were produced in this 
patient by immersing the hands in a i : 2000 solution of corrosive 
sublimate. 

In certain persons having an idiosyncrasy regarding this drug 
extreme salivation and stomatitis may be induced by the internal 
use or the external application of mercurial preparations in medici- 
nal quantities. 

Medicinal doses may produce, in susceptible persons, marked 
disturbances of nutrition, sensation, and motion to such a degree 
as to suggest poisoning. 

Poisoning. — Although mercury in a metallic state is compara- 
tively innocuous, its vapor is capable of producing violent and 
dangerous symptoms. All the salts are active poisons, especially 



232 A TEXT- BOOK OF MATERIA MEDIC A. 

that known as corrosive sublimate. The symptoms following toxic 
doses of this preparation resemble those occasioned by arsenic. 
The salt, however, being more readily soluble, produces propor- 
tionately more speedy and pronounced effects. They are, briefly, 
a strong, metaUic taste in the mouth, frequent and bloody evacua- 
tions, tenesmus, severe abdominal pains, vomiting, and labored res- 
piration. There may be suppression of urine, syncope, and perhaps 
insensibihty and convulsions. 

One of the most obstinate features of mercurial poisoning is 
ptyalism or salivation. This condition is first manifested by tender- 
ness of the gums and teeth. The gums are inflamed and covered 
by a white, sticky substance, and bleed at the sHghtest provocation. 
The breath is very offensive. The teeth become loose, and may 
drop out. Necrosis of the maxillary bones may appear, and ex- 
tensive ulcerations of the gums and cheeks frequently occur. 
Accompanying these manifestations is an enormous increase in the 
amount of saliva secreted, which in some instances literally runs 
from the mouth night and day, often depriving the patient of sleep. 
Not infrequently a swelling of the lymphatic glands is also ob- 
served. Articulation and deglutition are interfered with from swell- 
ing of the tongue and ulceration of the gums, cheeks, palate, and 
tonsils. These symptoms, together with the fever, anorexia, mus- 
cular weakness, and headache which are constant accompaniments 
of ptyalism, render the condition of the patient very serious and 
tormenting. 

Chronic mercurial poisoning , or inerctirial cachexia, is the effect 
produced by prolonged exposure to the fumes of mercury. The 
blood becomes thin and poor, with degeneration of the corpuscles. 
The person becomes emaciated, the heart is weak, and the whole 
muscular system impaired. Respiration is rapid and shallow, and 
the mental faculties are affected. Loss of memory, irritability of 
temper, melancholia, and, in rare cases, mania, may ensue. All the 
special senses are affected. Deafness, dimness of vision, impaired 
taste and sensation, as well as intestinal derangement, edema, 
articular pains, and generally disordered secretions, manifest them- 
selves. 

Mercurial cachexia frequently produces muscular tremors, usu- 
ally beginning in the upper extremities with gradual extension. 
Even paralysis of groups of muscles is often the result of chronic 
mercurial poisoning. 

TreaUnent of Poisoning. — In acute poisoning from corrosive sub- 



SPECIFICS. 233 

limate or other active salt of mercury it is necessary to evacuate 
the stomach as quickly as possible, and give white of eggs freely. 
The after-treatment is similar to that of other corrosive poisons — 
the use of demulcents and opiates. 

For salivation, potassium chlorate probably occupies the first 
place as a prophylactic and curative agent. It is employed as a 
gargle and mouth-wash in a 2 to 3 per cent, solution. An astrin- 
gent wash is frequently necessary. Such drugs as tannin, myrrh, 
krameria, etc. may be used for this purpose. Where there is ex- 
tensive ulceration of the mouth disinfectant and antiseptic solutions 
will be found desirable. 

In cases of chronic mercurial poisoning it is of primary import- 
ance to remove all traces of the drug from the system by means 
of iodides, the dosage being limited in quantity, but continued for 
some time. 

Elimination of the poison from the tissues may be accomplished 
in various ways — the potassium iodide administered alternately with 
magnesium sulphate, laxatives, sulphur baths, and sulphur given 
internally. A change of air, liberal and nutritious diet, and tonics 
are also necessary. 

Therapeutics. — Externally and Locally. — As a germicide, anti- 
septic, and antiparasitic the preparations of mercury are extremely 
valuable, the corrosive chloride of mercury being extensively em- 
ployed as an antiseptic in general surgery in strengths of from 
1 : 1000 to I : 10,000. 

In diseases of the skin due to animal or vegetable parasites there 
are no drugs so valuable as certain preparations of mercury, the 
ointment of ammoniated mercury being highly prized. 

Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 
Gm.) to I ounce (32.0 Gm.) is an efficient remedy in eczema. 

Indolent venereal ulcers are much improved by dusting them 
with calomel, while the early inflammatory conditions of these sores 
may be greatly benefited by the use of black wash. 

Many diseases of the eye, ear, nose, and throat yield to various 
preparations of mercury. The ointment of the yellow oxide of 
MERCURY is particularly adapted to phlyctenular ophthalmia, pannus, 
keratitis, chronic blepharitis marginalis, etc. 

Inunction with mercurial ointment or with oleate of mer- 
cury is excellent for the constitutional treatment of syphilis. These 
two preparations are of great value in subacute synovitis, pelvic 
cellulitis, and syphilitic orchitis and epididymitis. 



234 A TEXT-BOOK OF MATERIA MEDICA. 

The OINTMENT OF THE RED IODIDE OF MERCURY has a reputation 
as an efficient remedy in goiter and e?ilaigement of the spleen, as 
well as in pachymeningitis. 

The SOLUTION OF NITRATE OF MERCURY is an active and reli- 
able caustic in the treatment of phagedenic ulcerations and venereal 
ulcerations of the os uteri. 

The use of mercurials is usually attended with excellent results 
in promoting resolution of fibrous induration resulting from chronic 
inflammation. 

Internally. — The principal use of mercury is undoubtedly as 
an antisyphihtic. Mercury is an antidote against constitutional 
syphilis, being particularly efficient in the secondary stage. Many 
methods of mercurializing a patient have been adopted, mention of 
which will be made under " Administration." It is perhaps un- 
necessary to caution the therapeutist to make an accurate and 
positive diagnosis of syphilis before instituting the mercurial treat- 
ment, as otherwise the consequences may be disastrous. 

Mercury has been used in all stages of the disease, though^ 
possibly from ignorance of its proper use, its employment has met 
with less favorable results in the primary than in the secondary 
form, while a careful study of syphilology leads one to believe that 
in tertiary syphilis it is inferior to the iodides, if not, indeed, actually 
contraindicated. 

The medical uses of mercurial preparations in disorders of the 
alimentary tract are very numerous. 

Chronic dysentery will frequently yield to yq-q to -^-^ grain 

(0.0006-0.0001 Gm.) of CORROSIVE CHLORIDE OF MERCURY and 

diarrheas of children — particularly those characterized by pale, 
offensive stools — together with ileo-colitis of infants, are greatly 
benefited by small doses of calomel or gray powder, which will 
also allay obstinate vomiting. 

As a purgative in bilious attacks, hepatic congestion, and cirrhosis 
CALOMEL is an extremely valuable drug. Its action as a purgative 
will be more fully described under " Cathartics." 

This drug is also a remarkably efficient diuretic. 

The internal use of mercury is of great value in all nonsuppu- 
rative inflammations, as cirrhotic conditions in the glandular struc- 
tures, or in scleroses in the nervous system, such as hepatic cirrhosis, 
chronic interstitial nephritis, locomotor ataxia, chronic endarteritis, 
chronic affectiojis of the lungs and pleura, etc. 

Many acute febrile and inflammatory conditions, such as menin- 



SPECIFICS. 235 

gitis, pericarditis, and hepatitis, are sometimes benefited by the in- 
ternal administration of calomel, though in acute inflammations the 
chief value of the drug, whether specific or non-specific, is manifest 
in iritis and in acute bronchitis which shows a tendency to persist. 

Calomel given in from 10- to 20-grain (0.6- 1. Gm.) doses in 
cases of pneumonia is esteemed very highly by some authorities. 

Calomel and opium have been used and recommended by some 
physicians in the treatment of Asiatic cholera. 

The internal use of bichloride of mercury is unquestionably 
of much value in the treatment of diphtheria, and the subsulphate 
of mercury is an old and veiy effective emetic in membranous 
laryngitis. 

The author has often successfully treated marasmus of infants 
with bichloride of mercury administered three times a day in doses 
of from y|-^ to y^ grain (0.0005 -0.0006 Gm.). 

Contraindications. — Mercury is usually contraindicated in 
tuberculosis and in persons of strumous diathesis ; and, while it is 
of value when judiciously employed in chronic interstitial nephritis, 
it must nevertheless be given cautiously, and if the excretion of 
urine is diminished by its use, the drug should be immediately 
discontinued. 

Children, though not easily salivated, are very susceptible to 
other poisonous actions of calomel. 

Ordinarily, acute asthenic diarrhea and dysentery in adults would 
contraindicate the use of mercurials. 

Administration. — Mercuiy is introduced into the system by — 

1. Inunction. — The portion of the body upon which the prepa- 
ration is to be applied should first be thoroughly washed with soap 
and warm water, and the ointment well rubbed in with the palm of 
the hand. The best localities for application are the inner sides of 
the thighs, the sides of the chest, the axillae, abdomen, and back. 
An excellent way to mercurialize a child is to put the ointment on 
the abdomen beneath a flannel binder. An efficient means also of 
favoring absorption is to apply the ointment to the soles of the 
feet, when it will be rubbed in by walking. Mercurial ointment 
is ordinarily used for this purpose, 15 to 30 grains (i. 0-2.0 Gm.) 
being required for each inunction. Oleate of mercury when appHed 
externally should not be rubbed in, the simple application to the 
skin being sufficient. 

2. Fumigation. — The iodide, mercuric sulphide, and calomel are 
used in this manner. The latter preparation, being preferable, is the 



236 A TEXT-BOOK OF MA TERIA MEDICA. 

one ordinarily used. From 5 to 20 grains (0.3-1.2 Gm.) of calomel 
are put in a plate or a porcelain dish over a lighted spirit-lamp. 
These are placed under a cane-bottomed chair, in which the patient 
sits, nude, enveloped in a blanket reaching to the floor and fastened 
loosely about the neck. The calomel is volatilized by the heat, 
deposited in minute particles over the surface of the body, and read- 
ily absorbed. The fumigation should last fifteen to twenty minutes. 

3. Endermically . — Mercurials may be absorbed by dusting calo- 
mel and certain other preparations on ulcers, open wounds, etc. 

4. By the Rectum. — Mercury may be administered in the form 
of a suppository containing 5 to 10 grains (0.3-O.6 Gm.) of mer- 
curial ointment. 

5. Hypodermically. — From yj to -^ grain (0.005-0.01 Gm.) of 
the bichloride of mercury, dissolved in 5 to 10 minims (0.3-0.6 
Cc.) of distilled water, is injected deeply into the muscles of the 
gluteal region or in the subcutaneous areolar tissue of the back. 
The solution of peptonate of mercury has been used for this pur- 
pose, though the preparation which is the least objectionable is the 
solution of the formamidate of mercury, 16 minims (i.o Cc), cor- 
responding to \ grain (o.i Gm.) of mercuric chloride. 

A I per cent, solution of asparagin hydrargyrate has been 
highly recommended by Neumann for hypodermic use, the dose 
being about 15 minims (i.o Cc), equivalent to \ grain (0.0 1 Gm.). 

Numerous other preparations have been recommended, but 
probably possess no advantage over those mentioned. 

6. Internally. — In the treatment of syphilis nearly every prepara- 
tion of mercury has been employed, authorities differing in their 
choice. Bumstead prefers the bichloride, the mercurous iodide, 
and the mercurial pill ; Berkeley Hill, the red mercuric iodide ; 
Fox, the cyanide ; Hutchinson, the gray powder, etc. It matters 
little which of these preparations is used. That which agrees best 
with the patient is advisable. Calomel, gray powder, blue pill, and 
corrosive sublimate are ordinarily used in disorders of the ali- 
mentary tract. As a rule, the first two are preferable. 

ARSENIC. 

Acidum Arsenosum — Acidi Arsen5si — Arsenous 

Acid. JJ.H.^. 

(Arsenic Trioxide — White Arsenic.) 
Orig-in. — Arsenic has been found in minute proportions in many 
mineral waters. It is obtained in large quantities by roasting 



SPECIFICS. 237 

arsenical ores — cobalt, nickel, tin, and particularly arsenical iron 
pyrites — and purifying by resublimation. 

Description and Properties. — It is a heavy solid, occurring- 
either as an opaque white powder or in irregular masses, of two 
varieties — the one, amorphous, transparent, and colorless, like 
glass ; the other, crystalline, opaque, or white, resembling porce- 
lain. Frequently the glassy variety is found enclosed in an opaque, 
white crust. Contact with moist air changes the glassy into the 
white, opaque variety. Both are odorless and tasteless. 

Both varieties dissolve very slowly in cold water, the glassy 
variety requiring about 30, the porcelain-like about 80, parts of 
water at 15° C. (59° F.). Both are slowly but completely soluble 
in 15 parts of boiling water. Arsenous acid is but slightly soluble 
in alcohol, but is soluble in about 5 parts of glycerin. Oil of tur- 
pentine dissolves the glassy variety only. Both varieties are freely 
soluble in hydrochloric acid and in solutions of alkaH hydrates and 
carbonates. 

Dose. — i^Q -2Q grain (0.001-0.003 Gm.). 

Official Preparations. 

Liquor Acidi Arsenosi — Liquoris Acidi Arsenosi — Solution of Arsenous 
Acid. — Strength, i per cent, of arsenous acid. 

Description and Properties. — A clear, colorless liquid, odorless, having an acidu- 
lous taste and an acid reaction. 

Dose. — 2-10 minims (o. 1 2-0. 6 Cc). 

Liquor PotSssii Arsenitis — Liquoris Pot^ssii Arsenitis — Solution of Potas- 
sium Arsenite (Fowler's Solution). — Strength, i per cent, of arsenous acid. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

Arseni lodidum— Arseni I od id i— Arsenic Iodide. 

Origin. — Prepared by triturating in a mortar finely-powdered 
metaUic Arsenic and Iodine until they are thoroughly mixed ; or by 
mixing solutions of Arsenous and Hydriodic Acids, and evapo- 
rating. 

Description and Properties. — Glossy, orange-red, crystalline 
masses, or shining, orange-red, crystalline scales, having an iodine- 
like odor and taste ; gradually losing iodine on exposure to air and 
light. Soluble in 7 parts of water and in about 30 parts of alcohol. 
Arsenic iodide should be kept in glass-stoppered vials, in a cool 
place, protected from light. 

Dose. — 3^-8 gi*ain (0.002-0.008 Gm.). 



238 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation, 

Liquor Arseni et Hydr^rgyri lodidi — Liqudris Arseni et Hydr^rgyri lodidi 
— Solution of Arsenic and Mercuric Iodide — (Donovan's Solution), — Strength: 
I per cent., each, arsenic iodide and mercuric iodide. 

Description and Properties. — A clear, pale-yellowish liquid, without odor, and having 
a disagreeable metallic taste. 

Dose. — i-io minims (0.06-0.6 Cc). 

S5clii Arsenas— S5dii Arsenatis— Sodium Arsenate. 

JJ. S. P. 

Orig-in. — Prepared by heating to redness Arsenous Acid, Sodium 
Nitrate, and Sodium Carbonate. Dissolve the fused mass in water, 
and crystallize. Dissolve crystals in water, and recrystallize. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, odorless, and having a mild, alkaline taste (the salt is 
very poisonous). Efflorescent in dry air, and somewhat deliques- 
cent in moist air. Soluble in 4 parts of water, very soluble in 
boihng water, and slightly soluble in cold water. Soluble in 60 
parts of boiling alcohol. Sodium arsenate should be kept in well- 
stoppered bottles. 

Dose. — ^VtV grain (0.001-0.006 Gm.). 

Official Preparation. 

Liquor Sodii Arsenatis — Liquoris Sddii Arsenatis — Solution of Sodium 
Arsenate — (Pearson's Solution). — Strength: i per cent, of sodium arsenate. 
Dose, — l-io minims (0.06-0.6 Cc). 

Unofficial Preparations, 

Cupri Arsenis — Cupri Arsenitis — Cupric Arsenite — (Scheele's Green, Min- 
eral Green, Paris Green, etc.). — Dose, yip grain (0.0006 Gm.), daily, in divided 
doses. 

Liquor Arseni Bromidi — Liquoris Arseni Bromidi — Solution of Arsenic 
Bromide — (Clemens' Solution). — Strength : the equivalent of i per cent, of arsenous 
acid. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Liquor Arseni et Atiri Bromidi — Liquoris Arseni et Atlri Bromidi — Solu- 
tion of Arsenic and Gold Bromide. — Originated with, and recommended by. Dr. 
Barclay, and sold under the trade name " Arsenauro." Strergth : 10 minims (0.6 Cc.) 
contain ^2 grain (0.002 Gm.) of each salt. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Antagonists and Incompatibles. — Arsenic is incompatible with 
the salts of iron, silver, magnesia, Hme, copper, ammonium, and 
with vegetable astringents. 



SPECIFICS. 239 

Synerg-ists. — The Restoratives and nux vomica are synergistic 
to arsenic, 

Physiolog"ical Action. — Externally and Locally. — Applied to 
the skin, arsenic acts as a caustic, exciting violent inflammation. 
Its escharotic influence results in destruction of vitality in the 
affected parts, accompanied with sloughing. 

Internally. — Digestive System. — Except in very small doses 
arsenic acts as a severe gastro-intestinal irritant. Minute and 
medicinal doses stimulate the flow of gastric and intestinal juices, 
and augment peristalsis, improving the digestive and nutritive func- 
tions. When too long continued, the drug produces nausea, diar- 
rhea, and increased micturition, with a sensation of heat and dry- 
ness of the throat and stomach. Toxic doses are followed by 
violent gastro-enteritis. Indeed, in whatever manner introduced 
into the system, arsenic appears to have a marked selective action 
upon the gastro-intestinal tract. 

Circulatory System. — Cardiac action may be slightly stimulated 
by small doses, the experience of arsenic-eaters proving that the 
drug, so far from being necessarily deleterious, actually tends to 
invigorate the system. Large doses render the heart irritable and 
feeble and decrease the number of red corpuscles, rendering the 
blood less coagulable. Medicinal doses, while not increasing the 
number of red corpuscles, prevent their destruction in such dis- 
eases as pernicious anemia. Toxic doses induce, among other 
severe results, the characteristic arsenical symptom — fatty degen- 
eration of the cardiac muscle. 

Nervotis System. — The general effect of arsenic upon the brain 
and nervous system is that of a tonic — a property which is sup- 
posed to explain its antiperiodic nature, in which respect quinine 
alone is its superior. The cerebral functions are stimulated, even 
to the point of exhilaration. Experiments have shown that the 
sensory nervous apparatus is strongly and untowardly affected. 
The action finally involves the motor system, complete paralysis 
supervening. Medicinal amounts act as a nervous excitant, stimu- 
lating the trophic apparatus (Hare). Large doses produce dis- 
orders of motility and sensibility, tremors, and other serious 
symptoms. It has been noted that the continued use of arsenic 
produces tingHng and a sensation of numbness in the tips of the 
fingers. 

Under prolonged use arsenic tends to accumulate to a greater 
extent in nervous than in other tissues. Thus, according to 



240 A TEXT- BOOK OF MATERIA MEDIC A. 

Scolosuboff, if I part is found in fresh muscle, the proportion in 
the hver is 10.8 ; in the brain, 36.5 ; in the spinal cord, 37.3. 

Respiratory System. — Ordinary amounts effect no special change 
in respiration other than increased power and stimulation of the 
respiratory center. It has been held, with authority, that small 
doses stimulate the peripheral endings of the pulmonary vagi. In 
toxic doses arsenic acts as a powerful respiratory depressant. 

Absorption and Elimination. — Arsenic is readily absorbed by 
the blood. Its presence has also been detected in the viscera, bile, 
urine, sweat, the bronchial and intestinal mucous membranes, and 
even in the parenchymatous tissues. It is ehminated slowly from 
the system by the intestines, and rapidly by the urine ; possibly, 
also, by the bile and the skin. The saliva, milk, and even the 
tears, are said to share in the process of elimination. 

Medicinal doses prevent tissue-change, while large doses in- 
crease nitrogenous metamorphosis. The therapeutic action is cer- 
tainly to modify and improve nutrition. 

Temperature. — The temperature is unaffected by medicinal doses. 
Toxic doses are accompanied by a considerable rise in bodily heat, 
though the extremities are often cold. 

Eye. — Large doses of arsenic are followed by injection of the 
conjunctivae, eczema, inflammation, and edema of the lids. Zehn- 
der asserts that the prolonged administration of arsenic has caused 
retrobulbar neuritis, and Hutchinson believes vitreous opacities 
may result from such a course. 

Untozvard Action. — Differing from the characteristic symptoms 
of poisoning occasionally produced by medicinal doses in very 
susceptible persons, there are induced, not infrequently, restless- 
ness, headache, alopecia areata, bronchitis, hoarseness, disturbances 
of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- 
disia, icterus, lacrymation, photophobia, amblyopia, dermatitis, 
and various cutaneous eruptions, frequently followed by desqua- 
mation. 

An eruption resembling that of measles, produced by 3 drops 
(0.18 Cc.) of Fowler's solution, is reported by Macnal {Medical 
Times and Gazette, 1868). Falck reports a case in which arsenic 
produced a discolored sanguinolent eruption with erysipelatous 
swelling. Papules and erythematous pustules have also been 
observed. 

The variety of these eruptions is well, yet somewhat homeo- 
pathically, described by Imbert-Gourbeyre (quoted from Lewin) : 



SPECIFICS. 241 

" Eruptions petechiales ou ecchymoses, eruptions papuleuses, 
ortiees, vesiculeuses, erysipelateuses, pustuleuses, . . . telles sont 
les formes principales de I'arsenic, exanthematogene dans ses mani- 
festations a la peau." 

Poisoning. — Large doses of arsenic produce symptoms of acute 
poisoning, the drug almost immediately manifesting its character- 
istic effects upon the gastro-intestinal canal (to which it is a marked 
irritant), exciting active inflammation in its delicate membrane. 
Other symptoms are colicky pains in the stomach, looseness of 
the bowels, great pain in the esophagus, and edema of the face 
indicated by pufifiness under the eyelids. The passages are at 
length similar to the '' rice-water " discharges of cholera, although 
different from the latter in the presence of blood or serum. The 
purging becomes obstinate and exhausting. In certain cases other 
choleraic symptoms are especially manifested, as increasing cold- 
ness of the body and cramps. Among the more prominent symp- 
toms is violent vomiting, which, however, aids in eliminating the 
poison from the stomach. 

The effects of arsenic are somewhat variable, intestinal inflam- 
mation, as autopsies show, not always being present. The quan- 
tity requisite to produce poisoning is often dependent upon idio- 
syncrasy, minute doses having proved fatal, and large amounts 
followed by surprising recoveries. Frequently, in place of the 
usual sym.ptoms, profound coma occurs from which the patient is, 
perhaps, never roused. Convulsions and localized paralysis have 
also been observed. It is well established, too, that absorption of 
arsenic from a wound or from injection into the blood causes 
stomachic and intestinal effects often as severe as those attend- 
ing its ingestion. 

Various cutaneous symptoms are recorded, and in some cases 
the effects of arsenical poisoning strongly resemble those of acute 
yellow atrophy of the liver. 

Chronic Poisoning. — This malady is frequently due to the fumes 
or powder of arsenic inhaled in certain processes connected with 
the arts and manufactures or from manufactured products, such as 
wall-paper, certain dyes, textile fabrics, etc. The symptoms are 
similar to those accompanying full doses of the drug, save that 
they appear occasionally in a more aggravated form. Ordinarily, 
loss of appetite occurs, with nausea, abdominal pains, vomiting, 
mild diarrhea, and headache. The conjunctivae are injected, the 
eyes and nose watery. In severer cases peripheral neuritis may be 

16 



242 A TEXT-BOOK OF MATERIA MEDICA. 

induced, as well as herpes zoster and paralysis of the muscles of 
the limbs, particularly the extensors of the hands and feet. Ataxic 
gait and darting pains, with rapid loss of muscular power, are not 
infrequent. Death from arsenical poisoning, however, is commonly 
the result of gastro-enteritis or collapse. 

The post-mortem changes are usually characteristic of corrosive 
poisoning — ecchymoses, erosions, and softening of the mucous 
membrane. The lungs and bronchial membrane are frequently 
congested. There is also present marked fatty degeneration of the 
heart, kidneys, liver, and spleen. 

Treatment of Poisoning. — It is necessary that treatment be ex- 
peditious, and the agents and methods adopted carefully chosen. 
Vomiting often renders the use of the stomach-pump unnecessary, 
yet emetics are frequently serviceable, the cleansing of the stomach 
being of primary importance. Various antidotes have been suc- 
cessfully used, the best, chemically, being freshly prepared hydrated 
sesquioxide of iron, administered in water, 2 or 3 tablespoonfuls 
every fifteen or twenty minutes. Magnesia, chalk, and lime-water 
also serve as efficient antidotes. The temperature of the patient 
should be maintained, and demulcents (oil, milk, etc.) freely given. 
The after-treatment should include mucilaginous drinks, opiates if 
indicated, cathartics, and, in case of necessity, stimulants. 

Therapeutics.— ^;r/'^r;/<2//^ and Locally. — The chief use of 
arsenic locally is as an escharotic. For this purpose it is employed 
to destroy malignant growths, such as caiicer, sarcoma of the skin^ 
and multiple sarcomatous degeneration of the lymphatic glands. In 
the latter affection the parenchymatous injection of 5 minims 
(0.3 Cc.) of Fowler's solution, diluted with twice the amount of 
distilled water, is used. 

Many of the pastes and " quack " cancer remedies owe what- 
ever efficiency they possess to arsenic. Manec's paste contains 
arsenous acid, 15 grains (i.o Gm.) ; black sulphide of mercury, 75 
grains (5.0 Gm.) ; burnt sponge, 35 grains (2.3 Gm.). 

The noted poitdre caustique de Frere Cosme on du Rousselot is a 
similar preparation, containing about the same quantity of arsenic. 

The solution of arsenous acid is an excellent local application 
to warts and corns. If these growths are very firm and horny, 
their removal may be facilitated by the previous application of 
solution of potassa. When used over large surfaces arsenic should 
be applied in good strength and heroically, so that active inflam- 
mation may be excited and the danger of absorption lessened. 



SPECIFICS. 243 

Internally. — Arsenic is a peculiarly efficient remedy in chronic 
scaly skin diseases. 

Like all other specifics, it influences diseases of a chronic nature 
more favorably than acute disorders, invariably aggravating acute 
skin diseases. This drug, therefore, is one of the most valued 
remedies in psoriasis, lepra, and chronic squamous eczema. 

While arsenic cannot, perhaps, be classed as a specific in the 
above-mentioned diseases, it undoubtedly yields uniformly better 
results than any other single drug. 

The solution of potassa is a valuable synergist to arsenic in 
these conditions, especially in eczematous cases. 

Pemphigus, prurigo, acne, and lichen ruber have also been fa- 
vorably influenced by the continued administration of Fowler's 
solution. 

In the successful management of these chronic skin diseases it. 
is necessary that the preparation of arsenic employed be given in 
as large doses as can be tolerated by the patient, and the treatment 
continued unremittingly for a long period. 

Lymphoma, whether superficial or occupying the great cavities, 
is frequently benefited greatly by similar treatment. 

Asthma and bronchitis, whether acute or chronic, accompanying 
or succeeding scaly skin diseases, are singularly amenable to this 
medicine when the dose is carried to the full physiological Hmit. 
Another condition, dysmenorrhea, frequently noticed in women 
with a tendency to asthma or subject to chronic diseases of the 
skin, is often cured or greatly benefited by arsenic. 

The obstinate and often incurable disease known as pernicious 
anemia yields better to arsenic than to any other known remedy. 
The effect of the drug in this disease is not due to its increasing 
the number and quality of the red blood-corpuscles, but rather to 
its preventing or delaying their destruction in the portal circulation. 
It should be given continuously and in gradually increasing doses 
until symptoms of arsenical poisoning appear, when the increase 
should cease and the same dose be maintained for some time. By 
carefully watching the indications and by the timely use of lax- 
atives the dosage may be easily adjusted so that the full benefit 
may be derived from this invaluable drug. 

The statements in the preceding paragraph are applicable also 
to leukemia, whether splenic, myelogenic, or lymphatic, and to Hodg- 
Mn's disease. 

Arsenic ranks next to quinine in the treatment of malaria. 



244 A TEXT-BOOK OF MATERIA MEDICA. 

Chronic cases in which quinine has lost its power are generally 
benefited in a marked manner by arsenic. It is a peculiar fact that 
relapses are fewer after the arsenic treatment than after the use of 
quinine. Moreover, arsenic can be administered in intermitteitt 
fever, frequently with as favorable results as quinine would give. 

Arsenic can be employed in cases of malaria at all times with- 
out regard to the presence or absence of fever or chills. 

The netiralgias, anemia, and headache of malarial origin are 
singularly amenable to this medicine. 

In the treatment of malaria with arsenic it must be remembered 
that the paroxysms of ague are not relieved at once, as is the case 
when quinine is the medicament used ; but they recur with less 
severity, and are of shorter duration, gradually declining until they 
disappear altogether. 

Fowler first reported the remarkable efficacy of arsenic in 
neuralgia of the intercostal and fifth pair of nerves. It is equally 
valuable in these cases whether the disease be due to malaria or 
to general debility. 

The author wishes to recommend urgently the use of arsenic in 
pulmonary phthisis. In certain forms of this disease he regards it 
equal, if not superior, to any other remedy. It is useful, however, 
only in those conditions which are characterized by excessive 
expectoration and a slow degenerative process. The good results 
of the arsenic treatment in these cases is shown in a conspicuous 
manner by a marked improvement in the general condition of the 
patient, there being a lessened pulmonary secretion, a reduction in 
temperature, improvement of the appetite, and consequent increase 
of the body-weight. Arsenic is contraindicated in phthisis when 
the cough is harsh and paroxysmal, with but scanty expectoration 
and a tendency to pulmonary hemorrhage. 

If this drug is specific in any one disease, it is so in chorea, 
very rarely failing to effect a cure when judiciously administered. 
It should be given in full doses, and increased as tolerance is 
estabhshed. 

This medicine seems to act equally well in gastralgia. It is also 
an efficient remedy in gastritis or the vomiting of gastritis, espe- 
cially in that occasioned by the excessive use of alcohol. Many 
irritative conditions of the stomach are relieved by minute doses of 
Fowler's solution. Excessive peristalsis, resulting in diarrhea, 
coming on immediately after taking food, is usually cured com- 
. pletely by very small doses of Fowler's solution, alone or com- 



SPECIFICS. 245 

bined with an equal quantity of tincture of opium. Arsenic has 
also been recommended in gastric ulcer and cancer. 

It has proved of great service in hay fever, spasmodic asthma, 
and acute coryza. It is often very serviceable in catarrJial pneu- 
monia and in cJironic broncJiitis. Bromide of arsenic is highly 
recommended in diabetes mellitits. Rheumatoid artJiritis is more 
favorably influenced by the use of arsenic than by any other medi- 
cine. It should be employed in the treatment of chronic rheuma- 
tism. Even in secondaiy syphilis a combination of mercury and 
arsenic has produced better results, in some cases, than mercury 
alone. Anstie has recommended arsenic in angina pectoris, alleging 
that it mitigates the severity of the attacks. Chronic diarrhea, 
when induced by intestinal fermentation or chronic malarial infec- 
tion, is sometimes greatly benefited by this drug. Constipation, 
also, if due to deficient intestinal secretion, may frequently be 
relieved by the administration of small doses of arsenic. 

Albuminuria dependent upon imperfect digestion of albuminous 
substances is almost invariably relieved by Fowler's solution taken 
with meals. 

Certain nervous diseases of the aged, not due to malaria, such 
as melancholia and Jiypocliondria, are often relieved by small doses 
of this drug. 

Finally, arsenic is a valuable adjunct to iron in the treatment of 
simple anemia and chlorosis. It is thought by some clinicians to 
retard the progress of epithelioma, and particularly gastric and 
uterine cancer. 

Contraindications. — In acute skin diseases and pulmonary 
tuberculosis with a tendency to hemoptysis. 

Administration. — Arsenic should be given ordinarily after 
meals. There are certain conditions, however, requiring its admin- 
istration in small doses before meals. When it is desired to give 
arsenic in pill form, the arsenous acid should be used ; and for 
solutions the liquor potassii arsenitis is usually preferred. 

In syphilitic disorders Donovan's solution is an excellent prepa- 
ration to use. 

Children are much less susceptible to the drug than adults, 
often being able to take adult doses with impunity. 

During a course of arsenic the patient should be instructed to 
watch carefully for the first untoward manifestations, such as puf- 
finess about the eyes, itching of the conjunctivae, nausea, diarrhea, 
or numbness of the fingers. Any one of these symptoms is an 



246 A TEXT-BOOK OF MATERIA MEDIC A. 

indication that the dose should not be increased ; and it may be 
necessary to lessen the dose, or even to discontinue the remedy 
altogether, for a while. 

There are two methods of getting a patient thoroughly under 
the influence of the drug : 

1. Begin with a full dose of Fowler's solution, and decrease i 
minim (0.06 Cc.) a day until a minim (0.06 Cc.) dose is reached ; 
then repeat the method. 

2. Begin with a small dose of Fowler's solution, and increase i 
minim (0.06 Cc.) a day until untoward symptoms appear or the 
dose has reached 10 or 15 minims (0.6-1.0 Cc.) ; then either re- 
peat the method or decrease the amount i minim (0.06 Cc.) a 
day. 

Enormous doses of arsenic can be given hypodermically, and it 
is then much less toxic than when given by the mouth. Equiva- 
lents of 20 (1.2 Cc), 50 (3.2 Cc), and indeed 100, minims (6.5 
Cc.) of Fowler's solution have been given in this manner at a 
single dose without toxic symptoms. Arsenic often acts more 
efficiently when given in this manner than when given by the 
mouth. The liver has a strong elective affinity for arsenic, but it 
is absorbed through the alimentary canal with considerable diffi- 
culty. The toxic action expends itself almost wholly upon the 
stomach and upper portion of the intestine. The hypodermic use 
of arsenic distributes the drug through the system just as mercury 
is distributed by inunction, carrying it immediately to all parts of 
the system by the circulation. The arsenite of sodium is free from 
any objection for hypodermic use : it never causes the least sign of 
irritation. Fowler's solution is objectionable : it invariably causes 
much irritation, and frequently forms an abscess. 

Careful study of the effects of the drug in each case will make 
it possible to guard its administration so that tolerance can be 
estabhshed — a result much to be desired in order to secure the 
maximum benefit. 

Considering the enormous doses to which the arsenocophagi 
become habituated, failure in the medicinal administration of arsenic 
argues the want of ability to employ it scientifically. 

lodum—Iodi— Iodine. U. S. JP. 

Origin. — It is found in the ashes of sea-weeds and is prepared 
from the mother-liquor obtained in the purification of ChiH salt- 
petre. 



SPECIFICS. 247 

Description and Properties. — Heavy, bluish-black, dry and 
friable rhombic plates, having a metallic luster, a distinctive odor, 
and a sharp and acrid taste. It imparts a deep-brown, slowly 
evanescing stain to the skin, and gradually destroys vegetable 
colors. Iodine is soluble in about 5000 parts of water and in 10 
parts of alcohol, with a brown color ; also freely soluble in ether 
and in a solution of potassium iodide, with a brown color, and in 
chloroform or carbon disulphide, with a violet color. It should be 
kept in glass-stoppered bottles, in a cool place. 

Dose. — About \ grain (0.016 Gm.), although seldom given in 
substance. 

Official Preparations. 

Liquor lodi Compdsitus — Liquoris I5di Comp6siti — Compound Solution 
of Iodine (Lugol's Solution). — Iodine, 5; Potassium Iodide, 10; Distilled Water, to 
make 100 parts. Strength, 5 per cent. Dose, i-io minims (0.06-0.6 Cc), 

Tinctura lodi — Tinctiirae I5di — Tincture of Iodine. — Iodine, 70; Alcohol, to 
1000. Strength, 7 per cent. Dose, 1-5 minims (0.06-0.3 Cc). 

Ungufentum I5di — UnguSnti lodi — Iodine Ointment. — Iodine, 4; Potassium 
Iodide, I ; Water, 2 ; Benzoinated Lard, 93. Strength, 4 per cent. For external use. 

Syrupus Acidi Hydriodidi— Syrupi Acidi Hydriodidi 
—Syrup of Hydriodlc Acid. TJ. S. J*. 

A syrupy liquid containing about i per cent, by weight of 
hydriodic acid. 

Description and Properties. — A transparent, colorless, or only 
pale straw-colored liquid, odorless, and having a sweet and acidu- 
lous taste. 

Dose. — i-2 fluidrachms (2.0-8.0 Cc). 



Ammonii lodidum— Ammonii lodidi— Ammonium 
Iodide. V. S. P. 

Origin. — It is prepared by dissolving Potassium Iodide and 
Ammonium Sulphate in boiling Water, adding Alcohol, filtering, 
washing the filtrate, and evaporating it to dryness. 

Description and Properties. — Minute, colorless, cubical crys- 
tals, or a white, granular powder, without odor when colorless, but 
emitting a slight odor when colored, and having a sharp, saline 
taste. The salt is hygroscopic, and soon becomes yellow, or 
yellowish-brown, on exposure to the air and light, owing to the 
loss of ammonia and the elimination of iodine. Soluble in I part 



248 A TEXT-BOOK OF MA TERIA MEDICA. 

of water and in 9 parts of alcohol. Ammonium iodide should be 
kept in small, well-stoppered vials, protected from Hght. 
Dose. — 3-20 grains (o.i 8-1.2 Gm.). 

Potassii Iddiclum— Potassii I od id i— Potassium 
Iodide. U.S.B. 

Origin. — Iodine is dissolved in a solution of Potassa in hot dis- 
tilled Water. The solution is evaporated, and the residue heated 
with charcoal. Dissolve in boiling Water, filter, wash the filtrate, 
and crystallize. 

Description and Properties. — Colorless, transparent or trans- 
lucent, cubical crystals, or a white, granular powder, having a pecu- 
liar, faint, iodine-Hke odor, and a pungent, saline, and afterward 
bitter taste. Permanent in dry air and but slightly deliquescent in 
moist air. Soluble in 0.75 part of water and in 18 parts of alcohol ; 
also soluble in 2.5 parts of glycerin. Potassium iodide should be 
kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

Official Preparation. 

UnguSntum PotSssii lodidi — UnguSnti Potassii lodidi — Ointment of Po- 
tassium Iodide. — Potassium Iodide, 12; Sodium Hyposulphite, i; Water, 10; Ben- 
zoinated Lard, 77. For external use. 

Sodii lodidum— S5dii lodidi— Sodium Iodide. Z7. >S^. JP. 

Orig-in. — Prepared from a solution of Soda in a manner similar 
to the preparation of potassium iodide. 

Description and Properties. — Colorless, cubical crystals, or a 
white, crystalline powder, odorless, and having a saline and slightly 
bitter taste. In moist air it deliquesces and becomes partially de- 
composed into sodium carbonate and free iodine, assuming thereby 
a reddish color. Soluble in 0.6 part of water and in about 3 parts 
of alcohol. It should be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

Strontii lodidum— Strontii lodidi— Strontium Iodide. 

V.S.JP. 

Origin. — Prepared by neutralizing freshly prepared solution of 
Hydriodic Acid with Strontium Carbonate, concentrating the filtrate, 
and crystallizing. 

Description and Properties. — Colorless, transparent, hex- 



SPECIFICS. 249 

agonal plates, odorless, and having a bitterish, saline taste ; deli- 
quescent and colored yellow by exposure to air and Hght. 
Soluble in 0.6 part of water, also soluble in alcohol, and slightly 
in ether. It should be kept in dark, amber-colored, glass-stop- 
pered vials. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

ZTnci lodidum— ZTnci lodidi— Zinc Iodide. U.S.I*. 

Orig-in. — Obtained by dissolving Zinc Oxide or Carbonate in 
Hydriodic Acid, or digesting Granulated Zinc in 10 parts of Iodine 
and 20 parts of Water, and evaporating to dryness. 

Description and Properties. — A white, granular powder, odor- 
less, and having a sharp, saline, and metallic taste. Very deliques- 
cent, and liable to absorb oxygen from the air and to become 
brown from liberated iodine. Readily soluble in water, alcohol, or 
•ether. Zinc iodide should be kept in small, glass-stoppered bot- 
tles. 

Dose. — 1-3 grains (0.06-0.18 Gm.). 

Sulphuris lodidum— Sulpiiuris lodidi— Sulphur 
Iodide. U. S. I". 

Origin. — Prepared by heating Washed Sulphur and Iodine in a 
flask until the ingredients combine. 

Description and Properties. — Brittle masses, of a crystalline 
fracture and a grayish-black, metallic luster, having the odor of 
iodine and a somewhat acrid taste. Almost insoluble in water ; 
soluble in about 60 parts of glycerin ; very soluble in carbon di- 
sulphide. Alcohol and ether dissolve out the iodine, leaving the 
sulphur. Sulphur iodide should be kept in glass-stoppered bottles, 
in a cool place. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparation. 

UnguSntum Stilphuris lodidi — UnguSnti Siilphuris lodidi — Ointment of 
Sulphur Iodide. — Sulphur Iodide, 30 grains (2.0 Gm.) ; Lard, i ounce (30.0 Gm.). 
For external use. 

Plumbi lodidum— Plumbi lodidi— Lead Iodide. 

U. S. P. 

Origin. — Mix solutions of Lead Nitrate and Potassium Iodide, 
filter, wash the precipitate with Distilled Water, and dry it at a 
gentle heat. 



250 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — A heavy, bright-yellow powder, 
without odor or taste. Permanent in the air. Soluble in 2000 
parts of water ; very slightly soluble in alcohol, but soluble, with- 
out color, in solutions of the fixed alkalies, in concentrated solu- 
tions of the acetates of the alkahes, of potassium iodide, and of 
sodium hyposulphites, and in a hot solution of ammonium chloride. 
Lead iodide should be kept in well-stoppered bottles, protected 
from light. 

Dose. — 4- grain (0.013 Gm.), although, as a rule, this drug is 
employed externally. 

Arg-enti I5diclum— Argrenti lodidi— Silver Iodide. 

U. S. jP. 

Origin. — Aqueous solutions of Silver Nitrate and of Potassium 
Iodide are poured together ; the precipitate is then collected upon 
a filter and washed with Distilled Water and dried upon bibulous 
paper. 

Description and Properties. — A heavy, amorphous, light-yel- 
lowish powder, unaffected by Hght if pure, but generally becom- 
ing somewhat greenish-yellow, and having neither odor nor taste* 
Insoluble in water and alcohol. 

Dose. — \-2 grains (0.008-0.13 Gm.). 

Allied Compounds. 

lodi Bromidum — lodi Bromidi — Bromide of Iodine. — Origin. — Obtained by- 
heating together Iodine and Bromine. 

Description and Properties. — A dark, reddish-brown liquid, resembling bromine in 
appearance and sensible properties, but yielding a perfectly transparent, brown-red solu- 
tion with less than 6 parts of water. For external use. 

lodi Chloridum — lodi Chloridi — Iodine Chloride (Iodine Trichloride). — 
Origin. — Prepared by passing dry Chlorine Gas over dry Iodine. 

Description and Properties. — Orange-yellow needles, gradually changing to large, 
transparent, rhombic plates. It has a penetrating, pungent odor, resembling bromine. 
Soluble in 5 parts of water, and also in alcohol and ether. 

Dose. — \ grain (0,01 Gm.), and externally in j^-i per cent, aqueous solution. 



Antagonists and Incompatibles. — Iodine and the iodides are 
antagonized by most of the Restoratives. Iodine is incompatible 
with the alkaloids and most of the mineral salts and acids, and 
with ammonia. The iodides are incompatible with mineral acids 
and acid salts, bismuth subnitrate, alkaloids, silver nitrate, soluble 
lead salts, spirit of nitrous ether, potassium chlorate, hquorice, and 



SPECIFICS. 251 

preparations containing starch. The tincture of iodine is incom- 
patible with water and aqueous preparations. 

Synergists. — The specifics, alkalies, and remedies increasing 
waste. 

Physiolog'ical Action. — Externally and Locally. — Iodine is a 
powerful disinfectant and rubefacient, as well as vesicant, caustic, 
parasiticide, and antiseptic. When applied to the skin or mucous 
membrane it produces a yellow, brown, or black stain, and is irri- 
tant or caustic according to the strength and frequency of the 
application. The discoloration, however, can be easily removed 
by sodium hyposulphite or ammonia. 

It combines with the albumin of the tissues and prevents putre- 
factive changes. When tincture of iodine is frequently applied or 
large amounts are used, desquamation of the skin is produced, and 
sometimes rapid vesication, or perhaps sloughing. The blood- 
vessels of the organs subjacent to the area to which it is applied 
are reflexly dilated, rendering this drug an efficient counter-irritant. 

The vapor of iodine when inhaled produces considerable irrita- 
tion of the respiratory passages, exciting cough, sneezing, increased 
secretion of mucus, dyspnea, and more or less pain in the chest, 
although when inhaled in moderate amounts its antiseptic proper- 
ties exert a beneficial influence upon the bronchial tissues, prevent- 
ing decomposition of the secretions. 

The iodides have no local action. 

Internally. — Digestive System. — Taken internally in small doses, 
IODINE acts as a gastric tonic, minute doses acting as a sedative, 
allaying nausea. In other cases a single moderate dose may occa- 
sion gastric uneasiness, larger amounts intensifying the discomfort 
and causing violent vomiting, increased salivary flow, abdominal 
pains, and purging. 

The IODIDES in moderate doses produce a sense of warmth in 
the stomach, larger amounts acting like iodine, though less irri- 
tating to the gastro-intestinal tract than the latter drug. 

Owing to their rapid diffusibility, the iodides can be tasted in a 
few minutes after their ingestion, considerably increasing the flow 
of saliva. 

Circulatory System. — The effects of iodine and its salts have 
been variously reported, it being claimed that their tendency is to 
contract the vessels and cause increased cardiac action. Intro- 
duced into the veins, a slight increase, followed by decrease of 
pressure, has been observed. The rapidity of elimination from the 



252 A TEXT-BOOK OF MATERIA MEDICA. 

blood is doubtless an impediment to any marked action on the 
circulation. Trasbot claims that potassium iodide dilates the, 
blood-vessels, thereby increasing glandular secretion. 

The iodides are all supposed to be converted into the sodium 
iodide in the blood, without modifying the composition of that 
fluid. 

Nej^voiis System. — No special action is recorded, although the, 
potassium iodide is known to occasion unpleasant symptoms, in- 
cluding distress of mind and depression of spirits, accompaniedl 
now and then by lassitude and muscular debility — symptoms due 
rather to the influence of potassium upon the spinal cord. 

Respiratoiy System. — Little or no effect from medicinal doses 
has been noted. 

Absorption aitd Elimination. — Iodine and the iodides are rapidly 
absorbed by the mucous membranes generally, being found in the 
blood, mainly in combination with sodium. 

Elimination takes place by various channels — the urine, saliva, 
milk, intestinal and nasal mucous membranes. Salivary elimina- 
tion appears to be even more active than the urinary process, 
although the drug escapes largely through the kidneys, increasing 
the arnount of water, urea, uric acid, and phosphoric and sul- 
phuric acids excreted. At the points of elimination the iodine 
escapes in its nascent state, occasioning more or less irrita- 
tion. 

Temperature. — No effects have been noted, the temperature 
appearing to remain stationary even in the presence of decidedly 
untoward symptoms. 

Eye. — Beyond a local congestion of the minute vessels of the 
sclerotic coat under certain conditions little effect has been ob- 
served. The symptoms of ocular iodism at times present are 
described under " Poisoning." 

Uterus. — Small doses may increase or hasten the menstrual 
flow and act as aphrodisiacs ; larger doses have a marked anaphro- 
disiac effect ; while prolonged administration may result in atrophy 
of the ovaries. It has been maintained with authority that the 
catamenia are liable to increase, and that during pregnancy the 
drug may cause abortion. 

Untoward Action. — The untoward manifestations, in susceptible 
patients, are identical with those of iodism. 

Poiso7iing. — Taken in excessive doses, iodine acts as a poison, 
and has even produced death, though rarely. The symptoms of 



SPECIFICS. 253 

acute poisoning are those of severe gastro-enteritis, characterized 
by distressing stomachic and abdominal pains, accompanied by 
painful irritation of the esophagus, followed by violent purging and 
vomiting. 

An early symptom is a strong metallic taste in the mouth, to- 
gether with increased salivation. Suppression of urine, hiccough, 
and dysenteric pain have been reported in a fatal case resulting 
from external application (Biddle, p. 460). Very immoderate doses 
are attended with rapid and feeble pulse, deathly pallor, severe 
renal irritation affecting urinary secretion, and final loss of vital 
power followed by respiratory failure. 

The condition induced by prolonged or excessive use of iodine 
or its salts is known as lodism. Together with a metallic taste 
there are present tenderness of the teeth and gums, nausea and 
coryza or symptoms of gastric irritation, acneiform eruptions — 
even a vesicular and purpuric variety not infrequently occurs — 
while under continued dosage the coryza becomes more pro- 
nounced, accompanied by edema of the eyeHds, lacrymation, and 
ocular pains. Moreover, muscular twitchings, edema of the glottis, 
neuralgic pains, and atrophy of mammae, testicles, and other tis- 
sues occasionally supervene. Anemia and even cachexia are often 
manifest. 

Treatment of Poisoning. — The use of large amounts of starch, 
in the form of arrowroot or starch-water, has been successfully 
adopted as an antidote. Hypodermic injections of ammonia, 
strychnine, digitalis, alcohol, and atropine have been employed 
with excellent results, as tending to restore the circulation and 
assist respiratory movements. More recently bicarbonate of so- 
dium has proved an efficient antidote. 

The use of the stomach-pump and the application of heat to 
the body and extremities are naturally of the first importance. 

Therapeutics. — Externally and Locally. — The tincture, com- 
pound SOLUTION, and ointment are extensively employed as coun- 
ter-irritants and as aids to the absorption of fluid. The tincture is 
an efficient application to joints in chronic rhetwiatisni , gout, and 
synovitis, and in pleurisy, both for the purpose of aborting an 
attack and to aid the absorption of fluid when effusion has taken 
place. In neuritis, onychia, periostitis, venereal bubo, glajidular 
swellings, etc. the tincture, applied externally, will often be of 
service. 

This same preparation is of marked benefit when hypodermi- 



I 



254 ^ TEXT-BOOK OF MATERIA MEDICA. 

cally injected in goiter, particularly of the soft or cystic variety, 
hydrocele, empyema, extensive serous arthritic effusion unaccompanied 
by inflammation, spijial meningocele, and a7ial fistula. 

The tincture is also a very efficient application in chronic metritis 
and chronic endometritis. 

In many diseases of the skin iodine serves a useful purpose as 
a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans^ 
etc. especially indicating its use. 

Many chronic splenic and hepatic disorders are favorably influ- 
enced by an external application of the iodine ointment. 

The TINCTURE OF IODINE has been recommended as an efficient 
appHcation in recession of the gums attendant upon pyorrhoea 
alveolaris. 

The vapor of iodine is frequently employed in subacute ca- 
tarrhal deafness and in acute coryza. 

A mixture of tincture of iodine \ fluidrachm (2.0 Cc), carboHc 
acid 10 minims (0.6 Cc), glycerin and water, each, \\ ounces 
(45.0 Cc), has been highly recommended by Samuel Johnston in 
the treatment of chronic pharyngitis. 

As an inhalant in chronic laryngitis and phthisis iodine in some 
form is highly esteemed by many physicians. 

Internally. — One of the principal and most important uses of 
iodine and the iodides is in the treatment of secondary and tertiary 
syphilis. All the manifestations of this disease, such as syphilitic 
periostitis, ineni?igitis, endarteritis, gummata, paralysis, etc, are re- 
lieved by large doses of the iodides to saturation of the system. 
The more chronic the disease, the larger the dose required ; and 
the more acute the attack, the smaller the dose. 

Iodine is peculiarly useful in combining with and eliminating 
mercury from the system of patients suffering from merctirial 
cachexia, paralysis, etc. Other metals, lead, etc, are readily elim- 
inated by a course of potassium iodide. 

Potassium iodide is of marked utility in arresting the various 
manifestations of scrofida, such as inflammatioit and idceration of 
cartilaginous structures and mucous catarrhs, and hastening the reso- 
lution of adenitis and enlargement of lymphatics. 

With regard to the use of iodine in the treatment of aneurysm 
of the aorta Walshe says : " Not only has relief of neuralgic pains 
and of the general distress followed its administration, but the local 
pressure-symptoms have been mitigated, and firm thrombosis has 
taken place within the sac, while the area of pulsation and of per- 



SPECIFICS. 255 

cussion-dulness has exhibited sensible reduction." Other authori- 
ties have reported favorably of its use in this condition. 

As a cardiac tonic iodine is of undoubted value, being especially 
serviceable in fatty degeneration of the heart, and in usually miti- 
gating the symptoms of chrojtic valvular diseases of the heart, 
especially those of the aortic orifice. It is a particularly useful 
remedy in chronic asthma and bronchitis, and to hasten the removal 
of inflammatory products of pneumonia, pleurisy, and pericarditis. 

The spasmodic asthma of adults and the bronchitis of children, 
both of which alternate with eczematous attacks, are greatly 
reheved by the potassium iodide. 

Even hereditary astlima occurs at less frequent intervals and in 
a milder form when the patient is kept constantly under the influ- 
ence of moderate doses of this drug. And if there is any remedy 
which has a beneficial influence in acute tubercidar meningitis, it is 
potassium iodide. 

In the early stages of cirrhosis, whether of the liver or kidneys, 
as well as in sclerosis of the cord, it is an efficient remedy. The 
dropsy of splenic or hepatic induration is relieved by iodine, while 
in the various forms of muscidar rheumatism it is one of the most 
potent medicaments. It has been advocated as a successful remedy 
in sciatica and chronic gout. 

It unquestionably retards the changes in chroiiic interstitial 
nephritis, though the tincture of iodine in these cases is considered 
superior to the potassium iodide. 

Ammonium iodide is highly recommended as an efficient rem- 
edy in acute catarrhal pneumonia and capillary bronchitis. It is 
especially useful in catarrhal jaundice, and has, moreover, been 
suggested as a good remedy in hay fever and in malarial fevers. 

The SYRUP OF HYDRiODic ACID has been commended by Craig 
as a valuable agent in acute rheumatism. 

Contraindications. — The i Irug should be discontinued at once 
when symptoms of iodism appear. It is contraindicated also in 
pulmonary tuberculosis when there is rapid change taking place 
in the lung. The iodides should not be given immediately before 
or after the administration of quinine. 

Administration. — The sodium iodide is less active and toxic 
than the potassium salt. The strontium iodide may be used for 
the same purposes as the other iodides, and possesses the advantage 
of disturbing the stomach less, besides being less likely to produce 
iodism. 



256 A TEXT-BOOK OF MATERIA MEDIC A. 

The iodides should be given in a large quantity of liquid. Their 
unpleasant taste may be concealed to a considerable extent by 
dissolving them in carbonic-acid water or Vichy water. Milk, com- 
pound syrup of sarsaparilla, and currant and raspberry syrups have 
all been used for this purpose. 

It is said that tincture of belladonna or sodium bicarbonate 
prevents the coryza caused by the iodides. 

The syrup of hydriodic acid is quite pleasant to the taste, and 
has but little tendency to produce iodism or untoward effects. 
This preparation should always be administered upon an empty 
stomach. 

Colchicum— Colchici— Colchicum. 77. H, 1^. 

(Meadow Saffron.) 

Origin. — A plant indigenous in Europe, in the southern and 
central portions of which it is frequently found in pastures and 
meadows, flowering in September or October, and ripening its 
seeds in June following. The root and seeds are official. 

Description and Properties. — The root is about i inch (25 
Mm.) long, ovoid, flattish, with a groove on one side ; externally 
brownish and wrinkled, internally white and solid ; often in trans- 
verse slices reniform in shape, and breaking with a short, mealy 
fracture ; inodorous ; taste sweetish, bitter, and somewhat acrid. 

Dose. — 2-8 grains (0.12-0.5 Gm.) in powder. 

Official Preparations of the Root. 

Extr^ctum Colchici R^dicis — ExtrScti Colchici RSdicis — Extract of Col- 
chicum Root. — Dose, 1-2 grains (0.03-0.12 Gm.). 

Extractum Colchici RSdicis Fluidum — ExtrScti Colchici RSdicis Fliiidi — 
Fluid Extract of Colchicum Root. — Dose, 2-8 minims (0.12-0.5 Cc). 

Vinum Colchici R^dicis — Vini Colchici RSdicis — Wine of Colchicum 
Root. — Dose, 5-20 minims (0.3-1.2 Cc). 

Colchicum seeds are subglobular, about -^ inch (2 Mm.) thick, 
very slightly pointed at the hilum ; reddish-brown, finely pitted, 
internally whitish ; very hard and tough ; inodorous ; taste bitter 
and somewhat acrid. 

Both the root and seeds contain an active principle, colchicine y, 
which is present in greater proportion in the root. 

Dose of the Powdered Seeds. — 1-5 grains (0.06-0.3 Gm.). 

Dose of Colchicine. — roT~'ro g^^i^^ (0.00 1 2-0.00 1 Gm.). 



SPECIFICS. 257 

Official Preparations of the Seed. 

Extractum C61chici SSminis Fluidum— ExtrScti C61chici SSminis Fluidi— 
Fluid Extract of Colchicum Seed. — Dose, 1-5 minims (0.06-0.3 Cc). 

Tinctura Colchici SSminis— Tincturae C61chici SSminis— Tincture of Col- 
chicum Seed. — Dose, 10-30 minims (0.6-2.0 Cc). 

Vlnum C61chici SSminis— Vini Colchici SSminis— Wine of Colchicum 
Seed. — Dose, 10-30 minims (0.6—2.0 Co.). 

Antagonists and Incompatibles. — Alcohol and opium antago- 
nize the cardiac depression produced by colchicum. Tannic acid 
and vegetable infusions containing it are incompatible, forming an 
insoluble tannate with the alkaloid. 

Synergists. — Diuretics, purgatives, emetics, and alkalies pro- 
mote the therapeutic activity of colchicum. 

Physiological Action. — Externally and Locally. — Colchicum is 
a decided local irritant, and when applied to the skin acts as a 
rubefacient. The dust when inhaled excites sneezing. 

Internally. — Digestive System. — In small medicinal doses colchi- 
cum slightly stimulates the salivary, gastric, biliary, and intestinal 
secretions. If these doses are repeated for several days, a sensa- 
tion of heat is experienced in the epigastrium, accompanied by loss 
of appetite and frequently by nausea. Full medicinal doses may 
produce purging and colic. Larger doses occasion profuse watery 
and choleriform or bloody evacuations from the bowels, severe 
abdominal pain and tenderness, excessive vomiting — in fact, all the 
symptoms produced by a violent gastro-intestinal irritant. 

Circulatory System.— YwW. medicinal or larger doses produce 
great depression of the circulation, with a small, rapid, and thready 
pulse. The marked cardiac depression and collapse which occur 
when poisonous doses of colchicum have been taken are more the 
result of the severe gastro-enteritis than of any direct action upon 
the heart. 

Nervous System. — The nervous system is unaffected by medici- 
nal doses. Even when poisonous doses have been taken the 
intellect usually remains unimpaired, though Toulmouche has seen 
the drug induce marked cerebral excitement. Discordant state- 
ments have been made regarding the action of colchicum upon the 
nervous system. The drug evidently affects different persons dif- 
ferently. Thus numbness or prickling, muscular pains or spasms, 
and occasionally convulsions, have been noticed ; yet the recent 
investigations of Laborde and Houde upon the action of colchicine 
show that it has no influence upon the centers of intelligence and 
17 



?58 A TEXT-BOOK OF MATERIA MEDIC A. 

volition, and does not induce paralysis of central origin, either 
motor or sensory, though the sensory nerves are considerably 
depressed. 

Respiratory System. — Large or poisonous doses of colchicum 
render the respiratory movements slow and shallow. This action 
is not due to any direct effect upon the respiratory center, but 
reflexly to the depression occasioned by the violent action of the 
drug upon the gastro-intestinal tract. 

Absorption and Elimination. — Colchicum is quite rapidly ab- 
sorbed, and is eliminated chiefly by the bowels and kidneys, the 
skin sharing to some extent in the excretory process. Some ob- 
servers allege that colchicum does not increase the amount of 
urine or the excretion of urea and uric acid, while others claim 
that these substances are increased. The author's experiments 
are sufficient to satisfy him that the excretion of all these sub- 
stances is considerably heightened under medicinal doses of col- 
chicum. 

Temperature, — Under moderate medicinal doses the temperature 
is unaffected, though doses large enough to produce emeto-cathar- 
sis are followed by a reduction of temperature. 

Untoward Action. — Many symptoms described under " Poison- 
ing " have been produced by very small doses. It is a matter of 
speculation whether these untoward manifestations were due to a 
decided idiosyncrasy on the part of the patient, or to the fact that 
the preparation employed might have contained an unusually large 
percentage of the alkaloid. 

Poisoning. — The symptoms of poisoning by colchicum are vio- 
lent vomiting and purging, griping and intense pain in the abdomen, 
and at times excessive salivation or possibly convulsions. While 
death is for a time delayed under a poisonous dose, a fatal termina- 
tion is almost inevitable. Meanwhile the patient suffers excruci- 
atingly, being little relieved by treatment. 

Treatment of Poisoning. — All that can be done is to combat 
symptoms, giving opium for pain, oil and demulcent drinks for the 
irritation, and stimulants to counteract respiratory and cardiac 
depression. Washing out the stomach or the use of emetics may 
be required. Tannic acid serves as a partial antidote, precipitating 
the colchicine. 

Therapeutics. — Externally and Locally. — Colchicum has no 
local therapeutic action. 

Internally. — Colchicum is the typical vegetable specific. Its 



SPECIFICS. 259 

effects are in many ways analogous to those of mercury and iodine, 
even resulting in fatty degeneration of the liver, loss of hair, nails, 
teeth, etc. 

The drug is as valuable and certain a specific for gout as is mer- 
cury for syphilis. Gout in all its varied manifestations is relieved 
by this invaluable remedy. Dianliea, dysentery, dyspepsia, bron- 
c /litis, asthma, neuralgia, and eczema dependent upon a gouty condi- 
tion are singularly benefited by colchicum. 

This medicine, while quite efficacious in chronic rheumatism, and 
occasionally of some benefit in rheumatoid arthritis, is of no value 
in acute articular rheumatism. 

Its value is piore apparent in acute than in chronic gout, and in 
the first attacks than in succeeding ones. Chronic gout, as well as 
chronic rheumatism, yields better to a combination of colchicum 
and potassium iodide than to colchicum alone. 

Some physicians recommend hypodermic injections of colchi- 
cine into the sheath of the nerve in sciatica. The author's quite 
hmited use of this method has resulted in so much local irritation 
that he is prompted to caution the reader against the hypodermic 
employment of this drug. 

In combination with certain other agents colchicum serves an 
excellent purpose as a cholagogue, full doses being frequently very 
effective in relieving ascites due to obstructive diseases of the liver. 

Colchicum is sometimes employed as a drastic purgative in 
cerebral and portal congestion, although when given in doses suf- 
ficient for this purpose it occasions considerable nausea and abdom- 
inal distress. 

Colchicum has also been recommended in the treatment of 
gonorrhea and chordee. 

In doses of -^ grain (0.00 1 Gm.) colchicine has been suggested 
by Darier in certain inflammatory diseases of the eye. Hypochon- 
driasis resulting from renal insufficiency is frequently benefited by 
colchicum. 

Contraindications. — The drug would be contraindicated in 
acute inflammatory conditions of the gastro-intestinal tract. It 
should be cautiously administered to old people. 

Administration. — The liquid preparations are to be preferred, 
and, in order to secure the full curative effects of the drug, it is 
unnecessary to give it in doses sufficiently large to excite vomiting 
or purging. The initial dose, therefore, should be small, that it 
may occasion no gastric disturbance. 



26o A TEXT-BOOK OF MA TERIA MEDICA. 

The beneficial effects of colchicum may be enhanced by first 
emptymg the intestinal canal by means of a saline cathartic. 

The preparations of colchicum vary greatly in strength. The 
crude drug contains different percentages of the alkaloid, accord- 
ing to the season of the year in which the plant is gathered, the 
colchicum root collected in July and August containing the largest 
percentage of colchicine. Owing to this variation in strength the 
assayed tincture or the alkaloid is recommended as the best prepa- 
ration to use, though, because of its activity and poisonous prop- 
erties, the alkaloid should be given in very small doses at first — 
not to exceed y^ of a grain (0.0005 Gm.) two or three times 
a day. 

Gualaci Lignum— Gualaci Ligni— Guaiacum Wood. 

77. H. JP. 

(Lignum Vit^,) 

Orig-in. — The heart-wood of Guaiacum officinale L. and of Guai- 
a£U7n sanctum L., trees indigenous in the West Indies and on the 
northern coast of South America. The former is about 40 feet 
(12 M.) high, having evergreen pinnate leaves. 

Description and Properties. — The wood is heavier than water, 
hard, brown or greenish-brown, resinous, marked with irregular 
concentric circles surrounded by a yellowish alburnum ; splitting 
unevenly, when heated emitting a balsamic odor; taste slightly 
acrid. It contains from 20 to 25 per cent, of resin, its most 
important constituent. 

Dose. — J- 1 drachm (1.0-4.0 Gm.). 

Official Preparation. 

Guaiacum wood is contained in Decoctum Sarsaparillse Compositum, for which see 

Sarsaparilla. 

Gualaci ResTna— Gualaci Reslnae— Guaiac. TJ. S. I*. 

Origin. — The resin of the wood of Guaiacum officinale. 
Description and Properties. — Irregular masses or subglobular 
pieces, externally greenish-brown, internally of a glassy luster, and 
in recent guaiac usually reddish-brown, transparent in thin spHnters, 
fusible, feebly aromatic, the odor becoming stronger upon heating ; 
taste somewhat acrid ; powder grayish, turning green on exposure 
to air. Soluble in potassium or sodium hydrate T. S. and in alco- 



SPECIFICS. 261 

hoi, the alcoholic solution being colored blue by the addition of 
tincture of ferric chloride. 

The principal constituents of guaiac are — guaiaconic acid, guai- 
acic acid, guaiaretic acid, and a small amount of gum. These 
substances are insoluble in water, but soluble in alkahes. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

Pilulae Antimonii Comp6sitse — Pilulas (ace.) Antimonii Comp6sitas — Com- 
pound Pills of Antimony (Plummer's Pills). — Dose, i or 2 pills. 

Tinctura Guaiaci — Tincturae Gualaci — Tincture of Guaiac. — Dose, 30-60 
minims (2.0-4.0 Cc). 

Tinctura Guaiaci Ammoniata — Tincturae Guaiaci Ammoniatae — Ammoni- 
ated Tincture of Guaiac. — Dose, 30-60 minims (2.0-4.0 Co.). 

Unofficial Preparation. 

Emtilsum Guaiaci — Emtllsi Guaiaci — Guaiac Emulsion. — Dose, \-2 fluid- 
drachms (2,0-8.0 Cc). 

Antagonists and Incompatibles. — Spirit of nitrous ether and 
the mineral acids are incompatible with guaiac. Water is pharma- 
ceutically incompatible with the tinctures, precipitating the resin. 

Synergists. — Many of the diaphoretics and diuretics aid the 
action of guaiac. Colchicum, sarsaparilla, mezereum, stiUingia, 
sassafras, sanguinaria, and xanthoxylum are also synergistic. 

Physiological Action. — Externally and Locally. — Guaiac is 
antiseptic, and possesses mildly astringent properties, being used 
locally as a gargle. 

Internally. — Digestive System. — It increases the flow of saliva 
and gastric juice, producing a sensation of warmth in the epigas- 
trium. It also augments the secretions from the intestinal canal, 
excessive doses even causing vomiting and purging. 

Circulatory System. — Guaiac increases the force and rapidity of 
the heart's action and dilates the cutaneous blood-vessels. 

Nervous System. — No special action has been observed. 

Respiratory System. — The drug is an expectorant, increasing the 
production and excretion of bronchial mucus. 

Absorption and Elimination. — Though a colloidal substance, it 
is absorbed into the blood with considerable facility, being excreted 
chiefly by the skin, exciting free diaphoresis. The bowels, kidneys, 
and bronchial mucous membrane assist in the excretory process. 

Temperature. — Under doses sufficient to cause free diaphoresis 



262 A TEXT-BOOK OF MATERIA MEDICA. 

the temperature may be reduced. Guaiac has, however, no direct 
influence upon the heat-center. 

Uterus. — Large doses of guaiac induce contraction of the womb, 
the drug thus acting as an ecbolic. 

Untoward Action. — No special symptoms are manifest other 
than the gastro-intestinal disturbance mentioned, and occasionally 
headache and giddiness. 

Poisoning. — Guaiac cannot be classed as a poisonous substance. 
Excessive doses act as a gastro-intestinal irritant, although no case 
of death is recorded resulting directly from this drug. 

Treatme7it of Poisoning. — This should be symptomatic, and 
similar to the treatment of poisoning from colchicum. 

Therapeutics. — Externally and Locally. — Guaiac in some form 
is an excellent application m follicular tonsillitis, rheumatic pharyn- 
gitis, and quiitsy. For these cases the emulsion of guaiac serves 
as an efficient gargle, or the troches of guaiac may be used. 

Internally. — From the sixteenth to the eighteenth century 
guaiac was renowned as a cure for syphilis, having been introduced 
into Europe from San Domingo. The heroic manner, however, in 
which the drug was employed rendered the results more injurious 
than beneficial, so that the guaiac treatment was condemned, one 
of its most vigorous opponents being Paracelsus, to whom the 
reintroduction of mercury for the treatment of syphilis is largely 
due. Since we have learned to use mercury and iodine and its 
preparations intelligently the guaiac treatment of this disease pos- 
sesses only a historic interest. Nevertheless, the drug possesses 
properties which render it exceedingly valuable in chronic muscular 
rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. 

Guaiac is considered to be an efficient remedy in Imnbago and 
chronic gout. Its most important service, however, in therapeutics 
is in the treatment of quinsy. It is doubtful whether there is any 
drug which will modify the course of this disease or abort an 
attack of tonsillitis so readily as this medicine. The tincture of 
guaiac is the preparation usually employed for this purpose, \ 
fluidrachm (2.0 Cc.) being given in the form of an emulsion every 
three or four hours. 

Contraindications. — There are no marked contraindications to 
its use. 

Administration. — The tinctures are very acrid and disagreeable 
to the taste, and should be given in the form of an emulsion. The 
emulsion of guaiac, a formula for which is given in the Dispensa- 



• SPECIFICS. 263 

tories, is not unpleasant, and is altogether the best Hquid prepara- 
tion to give. 

The lozenges of guaiac, allowed to dissolve slowly in the 
mouth, serve as an agreeable and efficient method of medicating the 
throat with this drug. 

Sarsaparilla— Sarsaparillae— Sarsaparilla. TI. S. JP. 

Orig"in. — The root of Smilax officinalis Kunth and other species 
of Smilax growing in swampy forests in Mexico and as far south 
as the northern portion of Brazil. They are woody climbers, often 
attaining a great height. 

Description and Properties. — About ^ to ^ inch (3.17-6.35 
Mm.) thick, very long, cylindrical, longitudinally wrinkled, exter- 
nally grayish- or orange-brown ; internally showing a whitish and 
mealy or somewhat horny cortical layer surrounding a circular 
wood-zone enclosing a broad pith ; nearly inodorous ; taste muci- 
laginous, bitterish, and acrid. The thick, woody, knotty rhizome, 
if present, should be removed. 

Sarsaparilla contains an active principle, parillin, an acrid gluco- 
side which froths with water and otherwise closely resembles sapo- 
nin in its action. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Official Preparations. 

Dec6ctum Sarsaparillae Comp6situm — DecScti Sarsaparillae Comp6siti — 
Compound Decoction of Sarsaparilla. — Dose, 4-6 fluidounces (118.-178. Cc). 
10 per cent., with Sassafras, Guaiac-wood, Glycyrrhiza, and Mezereum. 

Extractum Sarsaparillae Fluidum — Extr^cti Sarsaparillae Fluidi — Fluid 
Extract of Sarsaparilla. — Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Extractum Sarsaparillae Fluidum Comp6situm — ExtrScti Sarsaparillae 
Fluidi Comp6siti — Compound Fluid Extract of Sarsaparilla. — Dose, \-2 fluid- 
drachms (2.0-8.0 Cc). 

Syrupus Sarsaparillae Comp6situs — Sj^pi Sarsaparillae Comp6siti — Com- 
pound Syrup of Sarsaparilla. — Dose, 2-4 fluidrachms (8.0-16.0 Cc). A Fluid 
Extract, 20 per cent., with the Fluid Extracts of Glycyrrhiza and Senna, and the Oils 
of Sassafras, Anise, and Gaultheria. 

Antag-onists and Incompatibles. — Alkalies and free iodine are 
incompatible with the official preparations of sarsaparilla. Corro- 
sive sublimate is said to be changed into calomel by the compound 
syrup of sarsaparilla. 

Synergists. — The specifics, diaphoretics, and diuretics. 

Physiolog-ical Action. — Sarsaparilla has no local influence. 



264 A TEXT-BOOK OF MATERIA MEDIC A. 

Internally its action is similar to that of guaiac, though not so 
energetic and irritant in large doses. 

Therapeutics. — As with guaiac, the history of sarsaparilla is 
full of interest. Introduced into Europe in the sixteenth century 
by the Spaniards, who had learned of its alleged virtues in consti- 
tutional syphilis in Peru, San Domingo, and Brazil, it retained its 
reputation as a specific in this disease for a century or more, when 
it was abandoned, only to be revived at the close of the eighteenth 
century. Since that time it has retained its place in medicine more 
through the wonderful virtues ascribed to it by nostrum-venders 
than to any real medicinal properties which it possesses. 

The consensus of competent opinion seems to be that sarsa- 
parilla can claim no special medicinal virtues other than its diuretic 
and diaphoretic properties. 

The compound decoction of sarsaparilla is probably the most 
useful official preparation, and appears to have been of some bene- 
fit in scrofula and strumous cutajieous affections. Indeed, some 
cases of constitutional syphilis have improved more rapidly under 
the administration of this preparation than when mercury or potas- 
sium iodide has been given alone. 

Contraindications. — There are none. 

Administration. — No special directions can be given for the 
administration of the various preparations. The compound syrup 
of sarsaparilla is quite pleasant to the taste, and is used extensively 
as a vehicle, particularly for potassium iodide. 



Stilling-ia— Stilling-iae— Stillingia. Z7. 8. P. 

(Queen's Root.) 

Origin. — The root of Stillingia sylvatica L., a perennial herb 
growing in dry and sandy soil in the Southern United States as 
far north as Eastern Virginia. 

Description and Properties. — About i foot (30 Cm.) long and 
nearly 2 inches (5 Cm.) thick, subcylindrical, slightly branched, 
compact, wrinkled, tough, grayish-brown, breaking with a fibrous 
fracture, showing a thick bark and porous wood, inner bark and 
medullary rays having numerous yellowish-brown resin-cells. 
The odor is peculiar and unpleasant ; the taste bitter, acrid, and 
pungent. 

The fresh root probably contains an active principle not yet 
determined. (Old roots are nearly inert.) It contains an acrid 



SPECIFICS. 265 

resin, sylvacrol, a volatile and a fixed oil, resin, starch, gum, and 
tannin. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

ExtrSctum Stillingiae Fluidum— Extract! Stillingiae Fluidi— Fluid Extract 
-of Stillingia. — Dose^ \-\ fluidrachm (1.0-4.0 Cc). 

Unofficial Preparatio7is. 

Dec6ctum Stillingiae — Dec6cti Stillingiae — Decoction of Stillingia. — Dose^ 
1-2 fluidounces (30-60 Cc). 

ExtrSctum Stillingiae Fluidum Compositum — Extr^cti Stillingiae Fluidi 
Compositi — Compound Fluid Extract of Stillingia. — Dose, 1-2 fluidrachms (4.0- 
^.o Co.). Stillingia, 130; Corydalis, 130; Chimaphila, 60; Iris, 60 ; Sambucus, 60; 
Xanthoxylum Berries, 30; and Coriander, 30; to make 500 parts Fluid Extract with 
Dilute Alcohol. 

Syrupus Stillingiae Comp6situs— Syrupi Stillingiae CompSsiti — Compound 
Syrup of Stillingia. — Dose, i fluidrachm to i ounce (4.0-30 Cc). Compound Fluid 
Extract, i, to Simple Syrup, 3 parts. 

Tinctiira Stillingiae —Tincturae Stillingiae — Tincture of Stillingia. — Dose, 
i-i fluidrachm (2.0 4.0 Cc). 

Antagonists and Incompatibles. — There are none affecting 
Stillingia. 

Synergists. — The same as for sarsaparilla. 

Physiological Action. — The action of stillingia resembles that 
of sarsaparilla, the drug increasing the various secretions and stim- 
ulating the heart and circulation. 

Therapeutics. — ^The medical uses are the same as those of 
sarsaparilla. 

Sanguinaria— Sanguinariae— Sanguinaria. JJ, S. JP. 

(Blood-root.) 

Origin. — The rhizome of Sangninaria Canadensis L., a low 
perennial, a native of Canada and the United States, where it grows 
in open woods in a rich soil. The rhizome should be collected in 
autumn. 

Description and Properties. — Of horizontal growth, about 2 
inches (5 Cm.) long and | inch (i Cm.) thick, cylindrical, some- 
what branched, slightly annulate, wrinkled, reddish-brown ; frac- 
ture short, somewhat waxy, whitish, with numerous small red 
resin-cells, or of a nearly uniform, brownish-red color ; bark thin ; 
odor slight ; taste persistently bitter and acrid. It contains a color- 



266 A TEXT-BOOK OF MATERIA MEDIC A. 

less alkaloid, sanguinarine , yielding red salts ; chelerythine, yield- 
ing lemon-yellow salts ; homochelidonine ; and protopine. 
Dose. — 2-20 grains (0.12-1.2 Gm.). 

Official Preparations. 

Extractum Sangainariae Fluidum — Extract! Sanguinariae Fluidi — Fluid 
Extract of Sanguinaria. — Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctiira Sanguinariae (15 per cent.) — Tincturae Sanguinariae — Tincture of 
Sanguinaria. — Dose, 10-60 minims (0.6-4.0 Co.). 

Unofficial Preparations. 

Acetum Sanguinariae — Aceti Sanguinariae — Vinegar of Sanguinaria. — Dose. 
15-40 minims (1.0-2.5 Cc.) ; as an emetic, I-4 fluidrachms (4.0-16.0 Cc.1. 
Sanguinarine Nitrate. — Dose, \t~\ gJ^^in (0.005-0.008 Gm,). 

Antagonists and Incompatibles. — The irritation and circu- 
latory depression occasioned by blood-root are antagonized by 
opium, atropine, etc., while the incompatibles are tannic and gaUic 
acids, alkalies, and metallic salts. 

Synergists. — The Specifics and the mineral and vegetable 
emetics aid the action of sanguinaria. 

Physiolog-ical Action. — Externally and Locally. — Sanguinaria 
is an irritant and a feeble escharotic. When the powder of blood- 
root is inhaled it produces great irritation of the respiratory pas- 
sages, with excessive secretion and violent sneezing. 

Internally. — Digestive System. — Medicinal doses occasion a 
sense of constriction in the throat and heat in the epigastrium^ 
increasing the secretions from the stomach, liver, and intestines. 
Excessive doses are followed by marked salivation, nausea, and 
vomiting, the drug acting as a systemic emetic. Very large doses 
cause great irritation of the intestines, producing hypercatharsis. 

Circulatory System. — At first the heart's action is increased and 
arterial tension raised, but these effects are followed by cardiac and 
circulatory depression. Poisonous doses sometimes result in car- 
diac paralysis. 

Nervous System. — Large doses diminish reflex excitability by 
paralysis of the spinal centers, occasionally producing convulsions 
of spinal origin. 

Respiratory System. — Medicinal doses of sanguinaria have no 
apparent effect upon the respiration ; poisonous doses, however, 
render the breathing slow and shallow, death resulting from as- 
phyxia due to paralysis of the respiratory center. The final col- 



SPECIFICS. 26y 

lapse is often preceded by convulsions arising from the accumulation 
of carbon dioxide in the blood from failure of respiration. 

Blood-root is a stimulant expectorant, increasing the secretion 
from the broncho-pulmonary mucous membrane. 

Absorption and Elimination. — The drug is quite rapidly ab- 
sorbed, and is eliminated by the intestines, stomach, skin, kidneys, 
and bronchial mucous membrane. 

Temperature. — Medicinal doses have no effect upon, but exces- 
sive doses lower, the temperature. 

Eye. — Poisonous doses produce dilatation of the pupils. 

Uterus. — Sanguinaria possesses emmenagogue properties. 

Untoward Action. — This does not differ from the poisonous 
action which follows. 

Poisoning. — Blood-root is an acro-narcotic poison, exciting sali- 
vation, violent vomiting, profuse watery evacuations from the 
bowels, and producing all the symptoms of gastro-enteritis. The 
muscular system is greatly relaxed, the pulse is slow, weak, and 
irregular, the skin covered with cold sweat, and finally collapse of 
the vital powers supervenes. Convulsions may precede a fatal 
termination, which is due to paralysis of the respiratory or cardiac 
center. 

Treatment of Poisoning. — The stomach should be washed out 
and diffusible stimulants freely given. Strychnine may be admin- 
istered hypodermically, and digitahs and amyl nitrite given if 
necessary. The pain and nausea may be relieved by morphine and 
atropine. The normal temperature of the body should be main- 
tained by external warmth. 

Therapeutics. — Externally a7td Locally. — The nitrate of san- 
guinarine — \ grain (0.015 Gm.) to I ounce (30 Cc.) of glycerin — 
has been recommended by Keyser in conjunctivitis gramdosa. The 
powdered blood-root has been employed as a sternutatory, and 
when mixed with two or three times the amount of powdered 
acacia or starch it has proved beneficial, in the hands of some 
physicians, in the dry form of atrophic rhi?titis. The pure powder 
is said to be an efficient escharotic to nasal polypi ?ind fungoid con- 
ditions of the mucous membrane. Some authorities claim it to be 
an effective remedy for cancer, and consider it a valuable stimulant 
for indolent ulcers. 

The decoction of sanguinaria has been employed as a gargle in 
scarlatinal angina. 

This drug is now seldom used locally, the irritation caused by 



268 A TEXT-BOOK OF MATERIA MEDICA. 

it being so great that patients can only with great difficuhy be per- 
suaded to submit to the treatment. 

Internally. — While possessing alterative properties and classed 
among the Specifics, one of the principal uses of sanguinaria is in 
acute broncJiitis, when the spasmodic element predominates and 
after the subsidence of the more acute symptoms. 

In atonic conditions of the stomach and bowels, with increased 
secretion of mucus, small doses of tincture of sanguinaria prove 
beneficial. The tincture is of equal value in duodenal catarrh with 
jaundice. 

As an emmenagogue and aphrodisiac blood-root has been suc- 
cessfully employed in functional ainenon^Jiea and dysmenorrhea, as 
well as in functional impotence with relaxation of the genital organs 
and daily seminal losses. 

Sanguinarine has been recommended in hysteria, either alone or 
associated with podophyllum. 

Protracted muscular rheumatism has apparently been benefited 
by this drug. 

Tincture of sanguinaria has served as an emetic in spasmodic 
laryngitis, though its depressing and irritating action renders san- 
guinaria much less desirable than certain other emetics. 

The drug is considered to possess marked alterative proper- 
ties, and is still frequently employed in the treatment of syphilitic 
and strumous affections of a chronic nature. 

It certainly appears to be a mild stimulant to the vegetative sys- 
tem of nerves, improving the circulation, nutrition, and secretion. 

Contraindications. — No special contraindication exists, unless 
it be an acute inflammatory condition of the stomach and bowels. 

Administration. — The nitrate of sanguinarine is the best prepa- 
ration to use in diseases of the respiratory tract. As a gargle the 
vinegar of sanguinaria is to be preferred, while, if the drug is to be 
employed as an emetic, the infusion, given in tablespoonful doses 
at short intervals, serves the best purpose. For other purposes 
the tincture is the most desirable preparation. 

The sanguinarine nitrate is best administered in pill form ; the 
liquid preparations should be given well diluted with water. 



Mezereum— Mezerei— Mezereon.— Z7. >S^. J*. 

Origin. — The bark of Daphne Mezereum L. and other species 
of Daphne, small shrubs about 2-4 feet (0.6-1.2 M.) high, indige- 



SPECIFICS. 269 

nous in hilly and mountainous regions of Europe, extending to 
the Arctic Circle and eastward to Siberia. 

Description and Properties. — Long, thin bands, usually folded 
or rolled into disks, the outer surface yellowish or brownish-yellow, 
with transverse scars and minute blackish dots, underneath of a 
light greenish color ; inner surface whitish, silky. Bast in trans- 
verse layers, very tough ; inodorous ; taste very acrid. The im- 
portant constituent is an acrid resin, mezerin ; it also contains a 
crystalline glucoside, daplinin. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparation. 

ExtrSctum Mezerei Fluidum — ExtrScti Mezerei Fluidi — Fluid Extract of 
Mezereon. — Dose, 1-5 minims (0.06-0.3 Cc). Mezereon is also one of the ingredi- 
ents in Decoctum Sarsaparillse Compositum, Extractum Sarsaparillae Fluidum Composi- 
tum, and Linimentum Sinapis Compositum. 

Antagonists and Incompatibles. — The glucoside is precipi- 
tated by tannic and free acids, and the resin by water, in which it 
is insoluble. 

Synergists. — All the vegetable specifics, with the exception of 
colchicum. 

Physiological Action. — Its action, both locally and internally, 
is quite similar to that of sanguinaria, but when appHed to the 
skin it is more of a vesicant than an escharotic, and taken inter- 
nally it is more of a diuretic than sanguinaria, in poisonous doses 
causing severe urinary irritation and other symptoms produced by 
a violent gastro-intestinal irritant. The treatment of poisoning 
would be the same as that prescribed under poisoning by sanguin- 
aria. 

Therapeutics. — It is employed as a masticatory in paralysis of 
the tongue and the muscles of deglutition, and as a counter-irritant 
in the form of an ointment. Internally it is now seldom if ever used 
alone, but in combination with other vegetable specifics it is pre- 
scibed in chronic rheumatism and in chronic syphilitic and non- 
syphilitic cutaneous diseases. 

Contraindications. — Acute inflammation of the stomach, bow- 
els, and kidneys. 

Administration. — As it is never given internally alone, no spe- 
cial instructions for its administration are necessary. The fluid 
extract freely diluted with water would, however, be the only 
preparation to use. 



270 A TEXT-BOOK OF MATERIA MEDICA. 

Xanthoxylum— Xanthoxyii— Xanthoxylum . JJ. S, B. 

(Prickly Ash.) 

Origin. — The bark of Xanthoxylum Americanum Miller and of 
Xanthoxyhiin Clava-Herculis L. Both species are native to North 
America, the first being shrubby and attaining a height of 10 or 
12 feet (3-3.6 M.), while the second species is a small tree some- 
times 30 or 40 feet (9-12 M.) high. 

Description and Properties. — Xanthoxylufn Americanum 
(Northern Prickly Ash) occurs in curved or quilled fragments 
about yV ^^ch (^ Mm.) thick; outer surface brownish-gray, with 
whitish patches and minute black dots, sHghtly furrowed, with 
some brown, glossy, straight, two-edged spines, linear at the base 
and about \ inch (6 Mm.) long ; inner surface whitish, smooth ; 
fracture short, non-fibrous, green in the outer and yellowish in the 
inner layer ; inodorous ; taste bitterish, very pungent. Xanthoxy- 
lum Clava-Herculis (Southern Prickly Ash) resembles the preced- 
ing, but is about -^-^ inch (2 Mm.) thick, and is marked by many 
conical, corky projections, sometimes f inch (2 Cm.) high, and by 
stout brown spines rising from a corky base, 

Xanthoxylum should not be confounded with the bark of 
Aralia spinosa L., which is nearly smooth externally, and beset 
with slender prickles in transverse rows. 

Prickly ash contains an acrid green oil, a colorless, crystalline 
resin, a bitter principle, sugar, ash, and tannic acid. 

Dose. — 10-30 grains (0.6-2.0 Gm.j. 

Official Preparation. 

Extractum XanthSxyli Fluidum— ExtrScti XanthSxyli Fluidi — Fluid Ex- 
tract of Xanthoxylum. — Dose, 10-30 minims (0.6-2.0 Cc). 

Physiological Action. — The action of xanthoxylum is quite 
similar to that of sanguinaria, though it is more of a stomachic 
tonic, sialagogue, diuretic, and diaphoretic, and not so much of a 
local irritant. It increases the heart's action and raises arterial 
tension. 

Therapeutics. — It is used locally as a masticatory for the same 
purposes as mezereon, and the decoction has been highly recom- 
mended as a gargle in chronic pharyiigitis. 

Internally its medical uses are the same as those of stillingia, 
mezereon, etc., although of more value in atonic dyspepsia. 



SPECIFICS. 271 

Contraindications and Administration are the same as for 
sanguinaria. 

Serum-therapy. 

Among the marvels of scientific research which have distin- 
guished our century no achievements are more remarkable, nor 
of greater moment to the welfare of mankind, than those pertain- 
ing to the field of biological, pathological, and therapeutic inves- 
tigation. Yet, brilliant as have hitherto been the triumphs of 
speculative thought and the deductions drawn from tireless ex- 
perimentation and practically applied to the curative art, the highest 
generalizations and most signal exhibitions of genius are perhaps 
related to the special phenomena revealed by the study of zymotic 
diseases. The limits of the present work preclude a detailed treat- 
ment of so extensive and complicated a subject ; yet a brief sum- 
mary, elucidating the theory and development of serum-therapy as 
exemplified in contemporaneous research, should be of interest 
as well as benefit to the student of modern therapeutics. 

A glance at the history of therapeutic procedure in the prophy- 
lactic treatment of infectious diseases shows that the general prin- 
ciple underlying all later discoveries was, however crudely, divined 
at a much earlier period than we are wont to suppose. In view 
of actual attainment it is natural that the mind should revert to 
the transcendent services rendered to mankind by Jenner ; yet it is 
known that the ancient Hindus and Persians, as well as the nomad 
tribes and caravans of Farther Asia, practised inoculation of equine 
virus, or horse-pox — the mammary pustule developed during early 
lactation in the horse, camel, and cow, and even in woman. 

The inoculation of human virus is of immemorial origin, proba- 
bly coeval with the importation of variola from Asia into Africa by 
the Saracens. Certain it is that as early as the tenth century the 
Arabs and Chinese adopted the custom of variolization, the inoc- 
ulation of small-pox, although the skeptical physicians of the age 
consigned the practice as a monopoly to women. 

In 17 17, Lady Montague, wife of the British ambassador at 
Constantinople, saw an old Thessalian woman whose immunity so 
impressed her that she practised the operation upon her own child. 
Writing from Adrianople, she says : *' They take the small-pox 
here for diversion ; I have tried it on my dear little son ; I am 
going to bring this useful invention into fashion in England." In 



272 



A TEXT- BOOK OF MATERIA MEDIC A. 



17 1 8 her desire was realized, King George II. adopting the practice 
in the royal family. Three years later the custom was introduced in 
France, being accepted by Chirac and Helvetius, although the 
decrees of the Sorbonne and the Faculty of Medicine condemned 
the innovation as " illicite et contraire a la loi de Dieu ;" notwith- 
standing which official malediction the practice of inoculation con- 
tinued to spread until supplanted by vaccination proper in 1800. 
The French peasants knew in the last century that the act of milk- 
ing cows infected with mammary pustule, where there was any 
lesion of the epidermis on the hands, conferred immunity against 
small-pox ; and the mountaineers have long been accustomed to 
collect the crusts resulting from vaccine disease, macerating them 
in water, and inoculating their children with the solution. 

The success attending these rude experiments in France was 
communicated by a Frenchman, Rabault, in 1768, to Dr. Pew, an 
English physician, who reported the matter to his friend Jenner^ 
who at once perceived the momentous import of the discovery. 
Meanwhile, in 1771, a Holstein schoolmaster vaccinated three 
pupils; and in 1774 an English farmer, having observed the pro- 
tection existing among his dairymaids, and having implicit con- 
fidence in the efficacy derived from inoculation of bovine virus, 
vaccinated his wife. 

It was reserved for Jenner, however, in 1776, to commence the 
systematic and exhaustive study of the subject destined to prove 
inestimably beneficial to mankind. It was, in truth, the year 
celebrated for his declaration of scientific independence, which, 
after long contumely and scurrilous ridicule, was to wrest from his 
humiliated adversaries every weapon of derision and reproach. 

His early experiments were but a repetition of the empirical yet 
prophetic test of the English farmer ; yet with his gifted insight 
and indomitable courage the field of discovery was greatly ampli- 
fied, the results being in accordance with scientific methods inspired 
by Jenner's originality and force. 

He found in the northern counties of England a certain form of 
ulcer upon the hands of those employed in dairies and immune 
against small-pox ; observed that the malady resembled the pus- 
tules affecting the udder of the cow, having apparently been occa- 
sioned by contact ; vaccinated an individual supposed to be un- 
protected against the disease, and subsequently exposed him to 
infection with triumphant impunity. A long interval of laborious 
investigation had led to this final test, and it was not until 1798 



SPECIFICS. 272, 

that Jenner published his first paper upon the subject, vaccination 
being transported to America in the following year. 

Such is the brief yet eloquent record of an achievement which 
experience has proved to be of incalculable benefit to man. To- 
day there is no question among the more enlightened members of 
the profession that the o-p^rdXion, properly performed, is an absolute 
safeguard against the infection of small-pox. 

Strange indeed is it that a century of comparative quiescence 
should have elapsed since Jenner pointed the way to the startling 
accomplishment of the present epoch. Yet not until Pasteur, in 
1880, announced to the world the issue of his labors touching the 
protective inoculation of animals was the broken thread of patho- 
genic research taken up anew, and the task of solving its mysteries 
resumed — be it said with profounder acumen and far more com- 
plete appliances than ever before. 

It is a matter of record how the French savant demonstrated 
that cultures of the baciUi of chicken-cholera, when thoroughly 
dried and long exposed to the air, lost their virulence, and that 
fowls inoculated with the attenuated virus were rendered insensible 
to the attacks of more energetic micro-organisms. It was, mutatis 
mutandis, a modification or development of the Jennerian principle : 
" L'histoire de la vaccine constitue la premiere etape d'une longue 
serie de travaux, qu'ont inspires les admirables decouvertes revelees 
par le genie de Pasteur. Le principe en est toujours le meme : 
attenuer un virus, et I'injecter a I'animal qu'on veut immuniser" 
(Bernheim). Yet in the far-reaching possibilities suggested by 
Pasteur's experiments the present was immeasurably in advance of 
previous attainment. 

The further appHcation of this discovery to other animal infec- 
tions confirmed by indisputable evidence the validity of the savant's 
theories and the efficacy of their practical illustration. A new 
light was shed upon pathogenic study ; all Europe felt the impulse 
given to scientific thought in its relation to therapeutic progress, 
and in the sanctum of the laboratory many a fervent recluse sought 
to amplify the knowledge already attained. 

A striking departure from Pasteur's method by Salmon and 
Smith, in 1886-87, led indirectly to the latest evolution of inocula- 
tive therapy. They showed conclusively that animals may be ren- 
dered immune against certain infectious diseases by inoculating 
them with filtered cultures containing the toxic products of patho- 
genic micro-organisms entirely free from the living bacteria to 

18 



274 A TEXT-BOOK OF MATERIA MEDICA. 

which they owe their origin. By this process immunity against 
the bacillus of hog-cholera was attained in pigeons, the disease 
being almost invariably fatal to these birds. A little later (1888) 
Roux, employing similar sterilized cultures, succeeded in protect- 
ing susceptible animals against the anthrax bacillus ; and more 
recently (1890) Behring and Kitasato have proved that immunity 
against the action of the tetanus bacillus may be conferred by the 
use of toxic products in solution freed from the presence of active 
germs — in a word, that purely chemical agents sufficed to attain the 
object hitherto deemed wholly dependent upon the influence of 
living bacteria. The significance of this discovery could hardly be 
over-estimated. By it the entire theory of causal phenomena — the 
protective force in which the immunizing property was supposed 
to reside — became modified. If not a living organism, but a chemi- 
cal substance, proved to be the immunizing agent, then resistance 
to toxic influences must proceed from some source other than bac- 
terial metabolism, some organic force inherent in the inoculated 
system. To ascertain the nature and operation of this bactericidal 
power and determine the rationale of acquired immunity now 
engaged the earnest attention of savants throughout the world. 

It was soon found that the lymph and blood of a normally 
healthy organism possessed in a degree this mysterious property 
of neutrahzing the toxic effects of bacterial action, and gradually 
the truth which had thus far eluded the most searching investiga- 
tion was revealed. Finally, by a series of experiments involving 
the rarest skill and discrimination, the resistant energy developed 
by the infected organism was traced to certain albuminoids pertain- 
ing to or dissolved in the blood-serum, the acute and comprehen- 
sive insight of Behring, especially, sustaining the new hypothesis, 
which speedily passed from the realm of conjecture to the assurance 
of experimental proof, culminating in the establishment of serum- 
therapy as a legitimate and auspicious field of therapeutic science. 
It should be observed that the remarkable discoveries of Koch in 
his chosen domain of bacteriology had exercised no little influence 
in guiding and confirming the wider researches of his successors. 

Before entering upon a consideration of practical details it 
should be stated that the theory and practice of serum-therapy 
are based upon the condition of the system, whether in man or the 
lower animals, which renders it inhibitive of bacterial development 
by opposing an effective barrier to the propagation of pathogenic 
germs. This self-protective antagonism pertaining to the indi- 



SPECIFICS. 275 

vidual organism is termed wmiunity, and may be either natural or 
acquired. 

By natural immunity is understood the absence of all personal 
predisposition toward certain infections or diseases, even under the 
most favorable exposure. A familiar example of this inherent, 
congenital unsusceptibility is found in poisoning by Rhus (R. toxico- 
dendron, R. venenata), some persons handling the plants and even 
chewing the leaves with impunity, while upon others the mere 
proximity of the poison has a toxic effect. 

Acquired immunity may be either accidental or artificial. In 
the former case protection is secured by a previous access of the 
disease — as, for instance, a child recovered from scarlet fever, who 
is rarely prone to a second attack. In the latter case the suscept- 
ibility is obviated by protective inoculation, it being known, to illus- 
trate, that an animal inoculated by injections of anthrax-poison is, 
after recovery from transient symptoms of disease, rendered arti- 
ficially immune — a fact demonstrated by the thoroughly scientific 
experiments of Pasteur. 

An eminent authority, Schleich, has declared that natural or 
spontaneous immunity does not exist, but that the protective qual- 
ity is created by the animal kingdom — either through a previous 
malady or, as more frequently happens, through transmission from 
progenitors to offspring. Syphilis or tuberculosis in parents, he 
maintains, confers upon children immunity from these diseases ; 
and the author cites in support of his theory that certain infections, 
such as plague and leprosy, have wholly disappeared from various 
countries because of the inoculation of succeeding generations and 
the consequent attenuation of the virus — exhaustion of the soil, as 
it were. Bernheim asserts that no animal is endowed with absolute 
immunity, but that, however strong may be the resistance of the 
particular organism, it must succumb to an excessive invasion of 
microbes or of toxic products. 

The doctrine of immunity has, not inaptly, been styled the 
theorem of which serum-therapy is the logical corollary ; yet it is 
only within a few years that the mystery which shrouded the entire 
subject has been dispelled. To-day, thanks to untiring researches 
in the fields of physiology, biology, and chemistry, we are ac- 
quainted, if not with its precise nature and origin, at least with 
many details intimately associated with its causation. Formerly 
supposed to be absolute in its relation to species and individuals, 
we now recognize that immunity is but relative, considerations of 



276 A TEXT-BOOK OF MATERIA MEDICA. 

climate, race, receptivity, character of pathogenic germs, and con- 
ditions of infection all entering as modifying factors into the devel- 
opment and exercise of this potent yet complex force. 

Chauveau has shown that Algerian sheep, relatively immune 
against anthrax, contract the disease under enormous hypodermic 
injections of culture ; on the other hand, a slight puncture of the 
aural epidermis is fatal to sheep in France, which, transported to 
Algeria, succumb to natural infection. Watson-Cheyne states that 
a single virulent bacillus may cause the death of a guinea-pig or 
induce septicemia in the mouse, provided these animals be pecu- 
liarly susceptible. Yet the guinea-pig is not affected by the injec- 
tion of a few baciUi from a septicemic mouse, while several thou- 
sands occasion only an abscess, although death ensues with higher 
dosage. Again, young white mice are quickly killed by the anthrax 
bacillus, while the same injection produces in the old only a local 
lesion. Cattle, though more am.enable to infectious disease than 
sheep, are but slightly affected by hypodermic injections. Hogs 
are but sHghtly sensitive to anthrax, while the immunity of car- 
nivora is proverbial. Meat infected with anthrax is innocuous to 
the dog, the cat, and the fox. 

Again, anthrax has but little influence upon birds or fowls, 
especially chickens, yet it has proved fatal to sparrows and pigeons ; 
and Pasteur overcame the immunity of chickens by plunging their 
feet in water, heat and cold, according to M. Roger, predisposing 
animals to infection, less by moderating bodily temperature than 
by disturbing the general economy and diminishing the power of 
resistance. 

As with anthrax, so in the case of glanders, peculiar to horses 
— the varying susceptibility to infectious diseases is apparent, bo- 
vine animals being wholly immune, and the hog, dog, singing- 
birds, and pigeons but slightly affected. 

In tuberculosis experimental injection of the same culture is 
followed by results widely diverse, certain animals being seized 
with acute phthisis, while others show marked resistance to the 
poison, although under excessive doses none is completely immune. 
In this connection it may be noted that clinical experience demon- 
strates the same pathological diversity in human beings. The 
goat, dog, ass, and sheep are rarely affected by tuberculous disease, 
yet all are susceptible to pathogenic inoculation. The monkey, 
seldom contracting the disease in his native haunts, becomes upon 
transportation remarkably prone to phthisical affections. With the 



SPECIFICS. 277 

exception of the dog, most of the carnivora are easily influenced 
by tuberculous contagion. On the other hand, cold-blooded ani- 
mals are singularly immune, inoculation of toxic germs producing 
no development of the disease, though fatal results may occur 
from systemic intoxication. 

These examples, which might be multiplied indefinitely, suffice 
to show the relative character of natural immunity. It may be 
added that the caprice of toxic infection becomes even more appa- 
rent in studying the physiological and pathological conditions of 
the same organism when subject to the modifying influences of 
climate, altitude, seasons, heat, cold, traumatism, diet, ventilation, 
etc., and the subjective considerations of age, sex, race, fatigue, 
splenetic influence, nervous lesions, alcoholism, auto-intoxication, 
and acquired or hereditary diathesis. Indeed, the pathological 
records of disease abound in curious, often inexplicable, data 
touching individual and racial immunity. The subject is important 
in its bearing upon serum-therapy, and furnishes a theme of profit- 
able study in its relation to the practical treatment of infectious 
disease. 

With regard to the rationale of immunity, the theories advanced 
in explanation of this occult yet indubitable force are many, and 
often greatly at variance. Eliminating those which may be re- 
garded as too fantastic for serious consideration, the more plausible 
conjectures refer the phenomena in question to cellular, humoral, 
humor o-cellular, and vaso-motor agencies. 

Prominent among competent opinions is the doctrine of phago- 
cytosis proposed by Metschnikofif. 

In 1883 Metschnikoff established the existence of an intracellular 
digestion, showing that nomad cells were capable of absorbing vege- 
table filaments ; that mesodermic protoplasm possessed the same 
power over bacteria ; and that in the higher animals this phagocytic 
function had its analogue in the digestive property of leucocytes, 
or white blood-corpuscles. Gliige observed that in hemorrhage 
of the nervous centers these corpuscles digest the disintegrated 
myelin, and in a fresh-water crustacean, daphne, they have been 
seen to gather about the spores of algae, penetrating the meso- 
derm. 

Metschnikoff multiplied these examples of cellular defence 
among invertebrates, distinguishing two sorts of leucocytes : the 
stationary (macrophages) and the mobile (microphages), the latter 
including the white globules of lymph, and especially of blood, of 



278 A TEXT-BOOK OF MATERIA MEDICA. 

which, together, they constitute about 20 per cent. It may be 
said that all organs contain elements of defence — macrophages. 

The experiments of Gabritschevsky, who has studied phagocy- 
tosis in diphtheria, are highly instructive. Injecting a pure culture 
of Loeffler's bacillus into the anterior chamber of a rabbit's eye, he 
saw the devastation wrought among the leucocytes, which appeared 
powerless to contend against the deadly germs. But after immu- 
nizing the rabbit with attenuated cultures previous to the injection 
of toxic bacilli, a battle-royal ensued, the phagocytic action of the 
leucocytes resulting in the signal triumph of the latter, so that at 
the end of eight hours not a single free bacillus was found in the 
chamber, all having been absorbed within the opposing globules. 

Yet, notwithstanding the plausibility of Metschnikoff's hypothe- 
sis and the striking significance of his experiments — embracing in 
epitome the whole theory of preventive inoculation — certain argu- 
ments of Behring and Kitasato, based upon experimental research, 
go far to disprove the validity of the doctrine he so zealously 
maintained. Still, although the substances which form the defen- 
sive property of phagocytes, and are so fatal to the pathogenic 
action of microbes, remain unknown to us, the fact of phagocyto- 
sis cannot be denied. 

It was natural in the light of new developments that investiga- 
tion should inquire whether the leucocytes constituted the only 
protective force within the organism. Then followed the theory 
that the humors in general possess microbicidal power — either 
through the presence of destructive elements and the secretion of 
soluble toxins or through the humoral capacity of withdrawing 
oxygen from the invading micro-organisms. To Buchner is chiefly 
due the early elucidation of the htimoral theory, and of first recog- 
nizing in serum bactericidal properties, he being followed by Behring, 
to whom is to be credited the more important labor of extending 
experimentation and proving that animals naturally immune against 
a certain disease may furnish serum endued with neutralizing power. 
Behring found that the blood and blood-serum of the rat, which 
is naturally immune against anthrax, possesses strong bactericidal 
properties, while those of mice, cattle, etc., very susceptible to anthrax 
infection, have none. 

Further research resulted in Behring's all-important law, es- 
tablished by searching experiment, that " the blood and blood- 
serum of an individual which has been rendered artificially 'nxvcixwn^ 
against a certain infectious disease may be transferred into another 



SPECIFICS. 279 

individual, with the effect of rendering the latter also immune, no 
matter how susceptible this animal is to the disease in question." 
This formulated doctrine became the fundamental motive in all 
future investigations, the culminating achievement of inoculative 
therapy being the announcement of Behring and Kitasato in 1890 
concerning the artificial immunity against tetanus and diphtheria 
conferred by blood-serum, including the first emphatic declaration 
that the power of rabbits and mice when rendered immune to re- 
sist tetanus-poisoning " is based upon the ability of blood-serum to 
neutralize the toxins produced by the tetanus bacilli." As Krieger 
well observes : " These toxins are the poisonous products of bac- 
terial metabolism, and are the causes of acute disease when circu- 
lating in the organism. Their effect is an intoxication of the system, 
while after the introduction of virulent germs the cause of the dis- 
ease is an infection r 

The moment had now arrived for applying the therapeutic test 
of serum to man. In every instance the validity of Behring's law 
was sustained, and, moreover, the invaluable discovery was made 
that the serum of individuals naturally immune against a certain 
disease possesses 710 immunizing properties for other individuals. 
This militated partly against previous theories, and proved conclu- 
sively that the protective agent is not a substance produced by 
nature in naturally immune animals, but the result of " an organic 
chemism " called into activity only by introduction of the corre- 
sponding poison or toxin. 

In diphtheria and similar infectious diseases, as in tetanus, the 
bacillus produces toxins, the effects of which can be neutrahzed 
only by the properly prepared antitoxin. It was even shown by 
Ehrlich that the law applied to intoxication by certain purely 
chemical poisons, such as ricin and abrin, injections of gradually 
increased doses of serum affording complete immunity. 

A third theory in regard to the causes of immunity, the hnmoro- 
cellular^ seeks to combine phagocytic and humoral agencies, on the 
ground that neither separately suffices to account for the phenom- 
ena observed. Such is the theory of alexins of Buchner — certain 
albuminoid substances in the blood which release the leucocytes 
at the point of infection, the bactericidal property being active 
rather than passive, as previously supposed. Although defended 
by able advocates, Hankin and others, the fallacy of certain prem- 
ises, as shown by Metchnikoff, served to invalidate the doctrine, 
while several eminent authorities have disproved the facts upon 



28o A TEXT-BOOK OF MATERIA MEDICA. 

which the original hypothesis was founded. Nevertheless, so 
high an authority as Bernheim may be cited in its favor. 

Lastly, the vaso-motor theory of Bouchard and others asserts 
the claims of physiology in determining the causes of immunity. 
Admitting the fact of phagocytosis, they contend that the emigration 
of leucocytes from the vessels occurs only through the action of 
the vaso-motor centers, whether by exciting the dilator or paralyz- 
ing the constrictor muscles. 

From these varying opinions it is as yet difficult to form a 
rational conclusion entirely in accord with physiological phenom- 
ena. In this connection the remarks of Bernheim may be cited 
as those of a highly competent authority. He says, while inclining 
to the humoro-cellular hypothesis, " Be it as it may, we can safely 
aver that relative immunity exists among the majority of animals. 
Against certain diseases this immunity may even be absolute. 
Thus rats, mice, and dogs are naturally immune against the mini- 
mum mortal dose of the Loeffler bacillus ; yet the serum from 
these animals when injected into other individuals is powerless 
to prevent infection — a point having an important bearing upon 
serum-therapy. Moreover, we know that man is frequently ex- 
posed to contagion without contracting a taint of infectious dis- 
ease. I myself, under the most unfavorable conditions occasioned 
by fatigue, have passed through epidemics of typhoid fever, 
cholera, and malignant influenza (la grippe) without the slightest 
contamination, and other practitioners have had a similar ex- 
perience. Meanwhile, it were folly to imitate those courageous 
experimenters who, wishing to prove their immunity against cer- 
tain diseases, have absorbed their pathogenic germs, not infre- 
quently with fatal results As many conditions tend to 

diminish the power of resistance in the human organism, so others 
fortify the system against the inroads of infection. Obedience to 
sound hygienic principles, a regulated and nutritious diet, and a 
healthy parentage render the individual capable of withstanding 
microbic influences which constantly assail him, his natural immu- 
nity being greatly reinforced by these favorable circumstances." 

Obscure as is the precise nature of the immunizing property 
possessed by serum, there is no question as to its marvellous 
potency. Behring and Kitasato showed that it was sufficient to 
mingle very small quantities of serum from an immunized subject 
with virulent toxins to inoculate with impunity animals sensible to 
infinitesimal amounts of pure toxins. In experiments made by 



SPECIFICS. 281 

MM. Roux and Vaillard the resistant force of antitoxin passes 
imagination. During their researches concerning tetanus bacilli 
they employed cultures which, when filtered, killed guinea-pigs in 
doses of 0.005 c.cm. ; yet one cubic centimeter of equine serum 
served to neutralize thirty times its volume of toxin, so that by 
the addition of o.oooi c.cm. of serum it was possible to neutralize 
completely the action of a mortal dose. In order to render a 
mouse immune the requisite quantity of antitoxin is so infinitesimal 
as scarely to be computed. In fact, serum is obtainable possessing 
an activity of one-millionth, the immunizing unit being the quan- 
tity necessary to protect one gram of a mouse's weight ; that is, 
one cubic centimeter of serum suffices to confer immunity against 
fatal dosage in 1000 kilograms of mice, or 70,000 of these ani- 
mals, each weighing about 1 5 grams. 

It will readily be understood that the discovery of so protective 
a force soon awakened therapeutic hopes which, if not completely 
realized in tetanus — largely by reason of the difficulties attending 
any treatment of so fatal a disease — have, on the other hand, in 
the case of diphtheria, been even more happily fulfilled than was 
anticipated. 

It is to be regretted, en passant, that in the use of the term 
antitoxin needless ambiguity should have arisen in the public mind, 
a fancied identity between the antitoxic and prophylactic power of 
serum being widely diffused. The association of the term with 
the preventive property of the immunizing agent — antitetanic, 
antidiphtheritic^ — has contributed not a little to this confusion of 
characteristic properties. In reality, nothing could be more erro- 
neous than to suppose coequal activities in the two forces, the pre- 
ventive property of serum being far more general than its antitoxin 
influence — as yet scarcely proven save in tetanus and diphtheria. 
In hog-cholera, typhoid fever, pneumonia, aviaiy septicemia, and 
cholera careful researches abundantly demonstrate that the serum 
of animals rendered immune against these diseases, while protect- 
ing the alien organism from microbic infection, has no power over 
bacterial products, or toxins. That the immunity is conferred apart 
from this latter agency is evidence that the protection is due to 
causes other than direct bactericidal action. 

It is because the present terminology is defective — antitoxin 
failing to denote the salient property of serum — that the more 
descriptive expression stimidinc has been suggested on high author- 
ity as a substitute. It may be observed, moreover, that a still fur- 



282 A TEXT-BOOK OF MATERIA MEDICA. 

ther confusion prevails in giving the name antitoxin to the substance 
injected as well as to the defensive proteids formed by its action 
upon the organism — an ambiguity which the use of the term 
" stimuline " would obviate. 

In considering the prophylactic effect of antitoxin, so intimately, 
allied to serum-therapy, it may be well to emphasize the distinction 
between vaccination as founded by Jenner and the new method. 

It was formerly sought to create immunity by inoculating the 
individual with the pathogenic micro-organism itself — the virulent 
germs of disease. To-day protection is found in the injection of 
soluble products secreted by the micro-organism, administered in 
progressive doses, or, as by the latest process, in the inoculation 

' of serum taken from an animal previously rendered immune. 

Herein lies the essential difference between vaccination and immu- 
nization — a distinction too often ignored. Vaccination can at most 
but prevent infection ; immunization is curative. The vaccinal sub- 

L stance possesses no power over the actual microbes and their 

I products : the immunizing agent is endowed with the remarkable 
P* i property of neutralizing the influence of pathogenic germs or of 

determining their destruction. Vaccination produces in the indi- 
vidual inoculated deterrent forces which serve to arrest bacterial 
development : in immunization the obstructive agents injected are 
prepared, as in the laboratory, by a separate organism. In this 

L . latter medium we have a true therapeutic remedy. 

F ' If we seek to draw the line of demarcation between the two 

methods more closely, we recognize that the modern doctrine 
of immunity rests upon wholly new and original researches quite 
distinct from those formerly pursued. Doubtless the immunizing 
property of serum was divined by those who adopted free vene- 

II I section in cachectic patients, abstracting the vitiated blood and 
' replacing it with venous injection of that supplied by a healthy 

organism. A certain antagonism had also been obser\^ed between 
infectious maladies mutually opposed in their development, one 
of which was prone to exert a curative action upon the othen 
Fehleisen in 1880 cited the phenomenal case of a woman afflicted 
with cancer of the breast, which after three successive operations 
still redeveloped rapidly. Finally erysipelas affected the cicatricial 
wound of the amputated breast, the new malady proving beneficial 
to the patient, since carcinoma was not renewed. From this and 
similar data Emmerich inferred that it sufficed to inject the serum 
of animals immunized with the streptococcus of Fehleisen to treat 



SPECIFICS. 283 

and cure (?) cancerous subjects, the toxins of streptococcus erysipe- 
latis preventing carcinomatous development. 

Having purposely dwelt at some length upon the evolution 
and general properties of serum-therapy, let us turn to the actual 
achievement of the method in its therapeutic relations to infectious 
disease. In view of well-authenticated and obvious records attest- 
ing the efficacy of the new treatment, the charge ''not proven" 
cannot properly be sustained. Yet the observation of Achalme, 
that it is well to accept new theories salis aim grano, is not inap- 
plicable ; and the wise admonition of Bacon in regard to books, 
that we should read " not to accept nor refute, but to weigh and 
consider," is equally apposite in estimating the value of scientific 
discoveries, however distinguished may be their claim to recog- 
nition. 

Tetanus. — The first proof that tetanus is an infectious disease, 
of bacillary origin, was furnished by Carle and Rattone, who in 
1884 reproduced the symptoms in a rabbit by inoculation of pus 
taken from a human tetanus wound. The bacilli were found in the 
adjacent soil, but it was not until 1889 that Kitasato succeeded in 
isolating pure cultures, proving conclusively the microbic nature 
of the disease. 

The earliest case treated with antitoxin was reported in 1891 
by a Bolognese physician. Dr. Gagliardi, the result being highly 
satisfactory. In the light of subsequent experiments it is of ab- 
sorbing interest. The patient, a man forty-five years of age, 
accidentally received a wound of the left foot while crossing a 
rice-field. Next day (May 12, 1891), the foot having swollen 
considerably, he consulted Dr. Gagliardi, who made an incision 
and applied antiseptics. May 19th the wound was healed, but 
four days later symptoms of trismus appeared, becoming acute 
May 24th. Injections of 5 per cent, carbolic acid in the vicinity 
of the wound produced no effect, and on June 3d opisthotonos 
and aggravated symptoms were manifested. The doctor now 
injected 0.25 c.cm. of Tizzoni's antitoxin, obtained from a strongly 
immunized dog, the treatment being followed by some im- 
provement. June 7th, relapse and tetanic spasms having super- 
vened, two more injections were administered, and the following 
day the patient gradually convalesced, being discharged as cured 
July 5th. The quantity of antitoxin sufficient to neutralize the 
tetanus-poison was less than i c.cm. In 1891-92 four other cases 
were treated with like favorable results, injections of 0.25 c.cm. 



284 A TEXT-BOOK OF MATERIA MEDIC A. 

twice a day, from two to six doses in all, being attended with com- 
plete recovery. When it is taken into consideration that the most 
authentic statistics of tetanus show a mortality of about '^Z per 
cent, and that by the above procedure it was reduced to 20 per 
cent, it is small wonder that the issue in these cases should be 
regarded as simply marvellous. And yet we have, after devious 
wanderings, reached but the threshold of the new science. 

In December, 1890, Behring and Kitasato demonstrated that 
the serum of animals rendered immune against tetanus by the 
injection of iodine trichloride in the blood was capable of neutral- 
izing tetanic poison, whether in the laboratory or in other animals, 
the property not being possessed by organisms not inoculated. 
Not only did they succeed in preventing infection, but they recog- 
nized in the serum a curative power, as shown in the inoculation 
and cure of mice. At the same time it was observed by Vaillard 
that the immunity conferred by the serum was of short duration, 
lasting only fifteen days. 

Kitasato's preventive injection — a mixture of living culture and 
gradually decreasing doses of iodine trichloride — was perfected by 
Behring, who successfully applied it to the mouse, rabbit, sheep, 
and horse. Various results of experimental research ensued, elicit- 
ing among other interesting phenomena the fact that removal of 
the spleen renders immunization impossible. In 1891, Vaillard 
showed that the serum of animals naturally immune is not anti- 
toxic, becoming so only after a powerful dose of tetanic poison, 
and that the spleen and the fluids of immunized subjects are devoid 
of antitoxic properties. 

One point in the doctrine advanced by Behring and Kitasato 
awakened the liveliest discussion : whether it was possible to cure 
disease by the serum of inoculated individuals. Tizzoni and Cat- 
tani had failed to attain this result, and had, moreover, recognized 
that the condition of immunity was transient. On the other hand, 
Behring had claimed the cure of tetanus in the sheep and horse, 
and Kitasato had obtained results equally positive in the case of 
mice. 

All doubt on this head was dissipated by Ehrlich in 189 1, who 
proved by experiments with ricin and abrin chat the antitoxic and 
immunizing property of serum varies greatly with the degree of 
immunity conferred. In seeking a favorable issue it was evident 
that in cases of failure the inoculation had fallen short of the 
degree requisite to render the serum curative. 



SPECIFICS. 285 

It should be added that in subsequent treatment Tizzoni, Cat- 
tani, and Vaillard met with perfect success in effecting cures. 

Thus far, the employment of serum as a curative agent had 
been confined to experiments upon animals. The results obtained 
urged its appHcation to human tetanus. The first attempt was 
made by Kitasato in 1891, the serum being taken from a rabbit. 
It was unsuccessful, the dose of serum employed being too feeble 
to cope with the gravity of the conditions presented. In 1892, 
Tizzoni and Cattani and others reported 8 cures with serum from 
immunized dogs. It was contended, however, that a comparatively 
mild form of the disease was treated. In France the results of 
similar treatment in 1892 were wholly unfavorable, but in 1893 the 
cure of a peculiarly aggravated case was authentically announced, 
amelioration of symptoms having occurred in three, and complete 
restoration in twenty, days. The injection was subcutaneous in 
the abdominal region, 300 c.cm. of equine serum from an immun- 
ized animal being given. The injections are said to be in them- 
selves harmless. 

Finally, MM. Roux and Vaillard formulated the mode of prep- 
aration of antitetanic serum, together with an analysis of its prop- 
erties and its curative application in man and the lower animals. 

It may reasonably be expected that future experiments with 
the antitoxin of tetanus, made with greater precision and untiring 
patience, will produce more favorable results. 

It is of primary importance to consider, first, whether sufficient 
amounts of immunizing serum are injected to combat the condi- 
tions of this most difficult disease, and, second, whether the doses 
are renewed often enough to arrest its progress or ensure immunity. 
These desiderata are sufficiently obvious, especially in view of the 
certainty that the antitoxin is wholly innocuous. 

Diphtheria. — It is in the treatment of this universal and terrible 
disease that serum-therapy has achieved its most signal triumphs, 
the marvels wrought by its influence attracting more and more the 
attention both of the medical profession and of the laity. 

The micro-organism of the malady was described by Klebs in 
1883, his investigations being quickly followed by those of Loeffler, 
who confirmed Klebs' discovery and announced that it was possible 
not only to isolate, but also to produce, cultures of the microbe. 
Roux and Yersin, as well as other savants, have established the 
fact that the germ is found only in the false membrane — especially 
its surface — and in the saliva or contiguous mucous membrane, 



286 A TEXT-BOOK OF MATERIA MEDICA. 

never developing in the circulating fluid either of the lymph or any- 
other portion of the organism. 

The bacillus frequenting the false membrane is rarely unaccom- 
panied, but is found associated with other micro-organisms which 
exert great influence upon the progress of the disease. It propa- 
gates rapidly upon solidified serum, bouillon, and gelatin, though 
not on potato, preserving its virulence for several months. In 
direct contact with light and air it perishes within a few weeks. 

The false membrane is artificially formed by painting with pure 
culture the buccal ulcers of the mucous membrane in rabbits, dogs, 
guinea-pigs, and chickens, the symptoms produced being those of 
human diphtheria, and frequently fatal. The researches of Loeffler 
indicate that no direct action is attributable to the bacillus, the sys- 
temic effects of the poison being rather those of a general intoxi- 
cation of unknown nature — an opinion sustained by the researches 
of Roux and Yersin. The microbe may be ejected by the mouth 
together with the false membrane, but oftener it remains in an iso- 
lated state ensconced in buccal and nasal cavities, perhaps for sev- 
eral days or even weeks. 

Although the discovery of the pathogenic micro-organism of 
diphtheria is of quite recent date, no time has been lost in seeking 
to determine the means of conferring immunity against the disease. 
To Behring (1889) is due the credit of having first indicated the 
method of immunization in the disease, as well as in tetanus, his 
investigations leading him to affirm that the process of conferring 
immunity by the soluble products of Loeffler's bacillus derived 
from immunized animals, combined with a solution of iodine tri- 
chloride, is positively innocuous and curative in diphtheria. 

Little progress was made by the experiments of earlier investi- 
gators, but, in 1 89 1, Aronson succeeded in immunizing rabbits 
against diphtheria by inoculation with cultures attenuated by the 
vapor of formaldehyde. The serum obtained possessed great im- 
munizing power, a single cubic centimeter sufficing to inoculate 4 
kilograms of animal weight against the minimum mortal dose of 
virulent cultures. 

Subsequently, Aronson applied this therapeutic method to 
numerous children affected with diphtheria, and affirmed with Behr- 
ing that serum-therapy was inoffensive and a sovereign remedy in 
a large number of cases. He obtained the serum from dogs and 
sheep, but declared that large animals were preferable, especially 
the horse. 



SPECIFICS. 287 

In order to formulate the dosage, Behring established a techni- 
cal scale in which one cubic centimeter of prepared serum is consid- 
ered a unit, the antitoxin supplied being of the strength of 60, 1 50, 
or 500 units according to the degree of immunity of the animal 
from which it is derived. The value of serum depends, he affirms, 
upon the difference between the original condition of, and the re- 
fractory state attained by, the animal under immunization. 

Notwithstanding the significance attaching to experiments hith- 
erto recorded, the thereapeutic application of serum-therapy to 
diphtheria may be said to date from the communication of Roux 
to the Congress of Buda-Pesth (September, 1894). From this 
moment clinical observations multiplied and statistics were reported 
from all parts of the world. 

In this memorable address the author ably reviewed the entire 
subject of serum-therapy, stating the relations of serum to the 
general economy and offering advanced and cogent suggestions 
concerning the employment of antitoxins to arrest the ravages of 
infectious disease. The early failures to cure tetanus were explained 
by the fact that the symptoms of the disease are frequently not 
manifested until it is too late to stay its progress. On the other 
hand, in diphtheria the evident appearance of the characteristic 
false membrane rendered it possible to treat the malady from its 
inception. The most approved, though complicated, methods of 
preparing the toxin were minutely described — either through the 
medium of bouillon as a host in contact with dry air, or a similar 
process in a current of moist air — and explicit instructions given 
regarding the attenuation of the poison by means of iodine, and the 
modus ope7'andi of administration in gradually intensified doses. 

" With regard to diphtheria associated with certain microbes," 
said M. Roux, " especially streptococcus, the results of sero- 
therapy have been far from satisfactory. I have often saved rab- 
bits treated six or eight hours after tracheal infection, although 
repeated injections of therapeutic serum were necessary : when 
treatment has been deferred twelve hours, the animals have inva- 
riably succumbed. 

" The efficacy of antidiphtheritic serum having been established 
experimentally, its application to the human malady was a natural 
consequence. All my experience occurred at the Hospital for Sick 
Children in conjunction with MM. Martin and Chaillou. From the 
1st of February to the 24th of July, 1894, 448 children were ad- 
mitted to the diphtheritic ward, of whom 109 died — a mortality of 



288 A TEXT-BOOK OF MA TERIA MEDICA. 

24.33 P^^ cent. Now, the average mortality from 1890 to 1895 
was 51.71 per cent, in a total of 3971 children. The advantage of 
serum-therapy, all conditions being equal, is 27.28 per cent, greater 
than under the former treatment. 

" Such are the gross statistics. It is necessary, however, to 
deduct from the foregoing 448 patients treated with serum 128 who, 
as the bacterial examination showed, were not affected with true 
diphtheria of the Klebs-Loeffler bacillus type, besides 20 desperate 
cases amenable to no possible treatment. The net statement, 
therefore, is 300 cases with jZ deaths — a mortality of 26 per cent, 
whereas a previous report, similarly computed, recorded a mortality 
of 50 per cent." 

M. Roux is quoted at length because his views are authoritative, 
embodying the most careful researches connected with serum- 
therapy in its application to diphtheria. With regard to the relative 
proportion of deaths, it is instructive to compare with his figures 
those of more recent investigators and medical practitioners. 

At an international Congress held in Munich in April, 1895, 
the merits of serum-therapy in diphtheria formed the subject of 
an interesting debate, eliciting reports from the most competent 
Continental authorities in which the efficacy of the new treatment 
was strikingly demonstrated. 

Dr. O. Heubner of the University of Berlin, comparing the 
statistics of the Berlin hospitals during 1894, stated that the mor- 
tality since the introduction of serum-therapy had been reduced to 
one-half of that recorded prior to that date, about 1500 cases being 
included in each period. Allowing for the condition of medium 
virulence which marked the disease, Prof Heubner believed that 
this factor alone could not account for the great difference in the 
mortality. Up to the present time, he said, reliable information of 
over 3000 cases had been obtained from all parts of the world in 
which the disease was treated with antitoxin serum. The average 
of cures was 80 per cent. Referring to clinical analysis of 300 
cases of diphtheria coming under his own supervision, he declared 
that the disease could be diagnosed only by identification of the 
diphtheria bacilli. Of 207 cases so diagnosed and treated in the 
Berlin Charite, the mortality in simple attacks was 10 per cent., 
and in more complicated ones 1 3 per cent. From personal expe- 
rience the speaker regarded, as the specific results of serum-treat- 
ment, the improvement in the febrile symptoms and the quickened 
cleansing of the air-passages — facts first noted since the introduc- 



SPECIFICS. 289 

tion of serum-therapy, and confirmed wherever the method was 
adopted. 

Prof. A. Baginsky of Berlin said that prior to the introduction 
of the treatment with serum the more difficult and sorrowful por- 
tion of his life had been spent in combating the disease, against 
which he felt absolutely helpless, the mortality for the past four 
years, in spite of every effort, having been 50, 33, 36, and 42 per 
cent, respectively. The deaths occurring under treatment of 525 
cases with Dr. Aronson's preparation had been 15 per cent. 

Prof von Widerhofer of Vienna stated that in 300 cases of 
diphtheria coming under his cognizance the average mortality was 
23.7 per cent. Excluding those that died within twenty-four hours, 
the disease having reached a very advanced stage previous to 
treatment, the mortality falls to 14.3 per cent. 

Prof von Ranke of Munich reported that of 124 cases treated 
in the six months previous, 26 children, or 22.4 per cent., died, 102 
cases presenting features of uncomplicated diphtheria. Compared 
with the mortality during the preceding eight years, the reduction 
was enormous, being less than half the minimum record for any 
year during that period. 

Prof von Mehring reported on 74 cases, all treated with serum 
on the first or second day, of which only 4 died, giving a mortality 
of 5 per cent. During the preceding five years 30 per cent, of his 
diphtheria patients had died. 

Prof von Noorden gave the results of his experience in 81 cases 
treated at the Frankfort Hospital. Most of them, unfortunately, 
were admitted at a late stage of the disease, generally on the third 
or fourth day, the severest symptoms being developed. Notwith- 
standing this obstacle, in place of the previous mortality of 45 per 
cent., only 23 per cent, was recorded. 

Dr. G. Seiz of Constance stated that of 27 cases treated with 
serum he lost only i, or 3.3 per cent. 

Prof Sigel, in charge of the Olga Hospital at Stuttgart, reported 
that the general mortality for the five years previous to 1894 was 
40.1 per cent., and 60 per cent, among those upon whom trache- 
otomy was performed in the first nine months of 1894 — in fact, up 
to the day on which the antitoxin treatment was commenced — the 
mortahty rising to 50.3 and 70 per cent, respectively. During the 
three months of serum treatment in 1894 there was an astonishing 
decrease in the number of deaths, the mortality falling to 12 per 
cent, in general and 20.3 per cent, in tracheotomy cases. 



290 



A TEXT-BOOK OF MA TERIA MEDICA. 



The reports, emanating from authorities of the highest standing, 
were of themselves conclusive testimony in favor of serum-therapy 
in diphtheria as immensely superior to former methods of treatment. 

An interesting resume of statistics, compiled from the library 
of the Royal College of Surgeons, England, by Dr. G. C. Crandall 
of St. Louis, Mo., emphasizes in comprehensive figures the expHcit 
■advance made within a few years in the scientific control of the dis- 
ease. The following table embodies the results of Dr. Crandall's 
timely study of the subject : 



Authorities. 



Locality. 



Cases 

treated with 

serum. 



Mortality 
in percent. 



Previous 

mortality 

in per cent. 



Vierordt Heidelberg . 

Ganghofner Prague . . 

Viederhofer Vienna . . 

Kossel Berlin . . . 

Baginsky (quoted by Virchow) . Berlin . . . 

Sonnenburg Berlin . . . 

Aronson Berlin . . . 

Ranke » Munich . . 

Soltmann ... Leipsic . . 

Risel Halle . . . 

Roux, Martin, and Chaillou . . . Paris . . . 

Lebreton Paris . . . 

Moizard , Paris . , . 

Washbourn, Goodall, Card, and 

others London . . 

White New York . 

Withington Boston , . 

Total number of cases 

Average mortality, per cent 

Previous average mortality, per cent 

Collective report of other observers in different 

countries 



55 
no 

lOO 

350 
303 
107 

190 

85 

122 
114 

300 

258 
231 

195 
32 
80 



14.6 
12.7 

25-3 
16.7 
13.2 
20.6 
14.0 
18.8 
18.0 
8.0 
26.0 
12.0 
14.7 

18.6 
25.0 
16.0 



58.0 
50.0 
42.8 
34-7 
47.8 
27.6 
37-0 
48.5 



517 
50.0 

311 

42.7 

45 -o 



2632 



16.8 



42,0 



4022 



17.1 



The official report from the Imperial German Health Depart- 
ment up to June 20, 1895, records 2228 cases, with a percentage 
of mortality of 17.3; and further German statistics (August 10, 
1895) include 10,240 cases in hospitals and private practice, 5790 
of which were treated with antitoxin serum, the number of deaths 
being 552 — a mortality of 9.5 per cent. 

Prof Eulenburg, the author of this report, reiterated the import- 
ance of early recourse to antitoxin, stating that when used within 
the first forty-eight hours the mortality was only 4.2 per cent. : 
delayed beyond this period, the percentage was increased to 16.8. 

In America the merits of serum-therapy have been amply 
attested by reports from various sections of the country, one of 



SPECIFICS. 291 

the most recent and instructive being that of the resident physi- 
cian of the South Department of the Boston City Hospital, as 
follows : 

"In the Boston Gity Hospital, from Feb. i, 1894, to Jan. 31, 
1895, before antitoxin was used, 698 cases of diphtheria were 
treated, with 266 deaths — a mortality of 38.1 per cent. Since the 
opening of the South Department, from Sept. i to Nov. 30, 1895, 
inclusive, when antitoxin was used in every case, 332 cases were 
treated, with 41 deaths — a percentage of 12.3. Of these 41 deaths, 
23 occurred within twenty-four hours of entrance. Eliminating 
these, there were 309 cases with 18 deaths — a mortality of 5.8 per 
cent." 

Finally, the statement of Prof Welch of Johns Hopkins Uni- 
versity, published in July and August, 1895, contains statistics of 
7166 cases of diphtheria treated with antitoxin, in which the mor- 
tality was 17,0 per cent., and 2276 cases treated otherwise with a 
death-rate of 42 per cent. 

The foregoing figures, selected from a mass of corroborative 
testimony, must certainly be regarded as an eloquent tribute to the 
virtues of serum-therapy. They are at least a striking illustration 
of what Virchow has called the " brute force " of the numerical 
argument. 

Touching the method of administration and collateral manifes- 
tations, Roux, in the communication previously cited, says : 

" The serum I have employed, derived from immunized horses, 
had an active strength of 50,000 to 100,000. To all diphtheritic 
patients entering the hospital 20 cubic centimeters of this serum, 
in a single dose, are systematically admiinistered, the injection being 
in the subcutaneous tissue, and not renewed should bacteriological 
examination prove that the disease was other than diphtheria. 
Should the existence of the disease be fully estabhshed, I have 
never observed the slightest discomfort resulting from the dose. 

" The injection is painless, and if made antiseptically should be 
attended with no accident. Twenty-four hours after the first injec- 
tion a second is made of 10 or 20 cubic centimeters, these two 
inoculations sufficing, as a rule, to ensure recovery. 

" Should the temperature continue high, a third injection of 
10 or 20 cubic centimeters is given. The average weight of chil- 
dren being 14 kilograms, the total dose constitutes one-thou- 
sandth, or in exceptional cases one-hundredth, part of their weight. 
Untoward sequelae are less frequent under the use of serum, 



292 A TEXT-BOOK OF MATERIA MEDICA. 

although I have observed symptoms of paralysis. Eruptions, also, 
allied to urticaria may be occasioned by the antitoxin. 

" The physiological effect of the serum is apparent in its action 
upon the false membrane, which ceases to develop within twenty- 
four hours after the fi^st injection, being detached after twenty-six, 
forty-eight, or, at most, sixty hours. In 7 cases only have I known 
it to persist longer. Let me add, in conclusion, that in treatment 
with serum I have studiously avoided the use of local appHcations, 
simply irrigating the throat with boiled water, to which was added 
perhaps 50 grams (per liter) of Labarraque's solution." 

In commenting upon the address of M. Roux, Dr. Behring 
added that ''the specific action of antidiphtheritic serum is the 
surer and more rapid in proportion to the heroic nature of the dose. 
Since the injection is positively harmless, it may be adopted with 
impunity even in simply suspected cases of the disease." 

The prophylactic property of equine serum is well attested by 
Aronson, who employed antidiphtheritic injections to immunize 
children in families where the disease was estabhshed. One cubic 
centimeter of prepared serum sufficed for his purpose, of 130 chil- 
dren thus treated preventively only 2 being affected with a very 
mild form of the disease. 

It is impossible, says Bernheim, to assign a definite duration 
to the antitoxic property of serum. It may last several weeks, or 
even months, according to the strength of the injection and the 
species of animal under treatment. But, he adds, when definite 
immunity has been attained the protective power of serum may be 
prolonged by the injection of a small quantity of toxin every 
fourteen days. 

Concerning the various untoward complications arising from the 
use of serum and authentically reported, it is fair to say that the 
same phenomena are observed in diphtheritic patients treated by 
other methods than serum-therapy. 

Notwithstanding the eminent success of the method herein con- 
sidered, it should be said, in conclusion, that several important 
features are as yet but imperfectly formulated or even understood.^ 

1 In a paper upon the subject "Antitoxin," Prof. A. C. Cotton, M. D., of Rush Medical 
College, Chicago, puts the case thus strongly : 

" What we do not know is how much antitoxin exactly is necessary to neutralize 
a given quantity of toxin at somewhat lengthened periods precedent. What we do not 
know, and what we most particularly desire to know, inasmuch as it is about the only 
phase of the entire subject that has any practical bearing upon our profession as life- 
savers, is what number of antitoxin units is necessary to neutralize an indefinite amount 



SPECIFICS. 293 

It is of paramount interest to ascertain, for example, the precise 
prophylactic power of the immunizing serum. Behring has already 
directed his attention to this problem, advising the injection of 5 
cubic centimeters of serum in children under ten years of age, and 
10 cubic centimeters in older patients. Crouzon, who has prac- 
tised these preventive injections in 230 cases, reports but two light 
attacks of the disease. A similar experience is that of Baginsky 
in Berlin. Bernheim asserts that he has personally injected serum 
in 28 subjects exposed to diphtheritic infection without noting a 
single case of the malady. The dose employed was somewhat in 
excess of that proposed by Behring, being from 10 to 20 cubic 
centimeters, as recommended by Hilbert, the injection being twice 
repeated at intervals of twenty days. 

From a careful consideration of the subject in its relations to 
diphtheria, we may safely conclude — 

1st. That immunized serum forms a remedy which experience 
proves to be wholly innocuous and eminently adapted for use in 
human infection. 

2d. That antidiphtheritic serum has in every respect corre- 
sponded with the most sanguine hopes of its advocates, its employ- 
ment being attended with astonishing success wherever properly 
used and in sufficient quantities. 

3d. Finally, that it is incontrovertibly established that by means 
of injecting serum temporary immunity from infection may be 
readily conferred, permanent protection being contingent merely 
upon a renewal of treatment. 

In view of the extraordinary rapidity with which recent discov- 
eries have been made, it is unwise to presume that we have by any 
means exhausted the possibilities of serum in its dominion over 
this dread disease. Resources of science undreamed of in the past 
are now concentrated upon the momentous problem of infection. 
What new light future investigation may shed can be regarded only 
as a theme for hopeful conjecture. 

Tuberculosis. — It may be stated, in general terms, that the 
microbic nature of tuberculosis was admitted by nearly all writers 
upon the subject before the discovery of the pathogenic micro- 
organism. Villemin in 1866 had established by experiment the 

of diphtheria toxin of unknown virulence that has invaded at a prior indefinite time, 
and is presumably hourly continuing to invade, in unknown strength and quantity, from 
a patch of recurrent and extending culture of Klebs-Loeffler bacillus on an unknown 
extent of mucous surface of a human being of unknown susceptibility." — The Corpuscle, 
Dec, 1895. 



294 A TEXT-BOOK OF MATERIA MEDICA. 

infectious character of the malady ; but in France the idea seemed 
almost revolutionary, creating no enthusiasm, it being reserved for 
Germany, through the indefatigable labors of Robert Koch, to 
develop and elucidate the theory conceived by Villemin. Koch 
discovered the bacillus of tuberculosis, and even succeeded in iso- 
lating and cultivating it, the pure cultures obtained by him always 
producing tuberculosis in every form. His original communication, 
addressed to the Physiological Society of Berlin, bore date of 
April lo, 1882, and at once stimulated experimental research in 
others, who fully confirmed his discovery. 

The tubercle bacillus is aerobic, its existence depending wholly 
upon the supply of oxygen — a fact readily explaining its predilec- 
tion for the pulmonary tissue. The bacillus may affect all warm- 
blooded animals, although in different degrees, the microbe being 
somewhat differentiated in the lesions of birds and those of man 
and the mammalia in general. 

Spontaneous tuberculosis is extremely frequent in man, it being 
estimated that one-fifth of all fatalities are due to phthisis in its 
various forms. It is equally common among cattle, in which the 
progress of the disease and its lesions are precisely similar to those 
observed in human beings — a fact demonstrated by the admirable 
studies of Koch respecting pulmonary lesions and their character- 
istic pathogenic micro-organisms. 

Like other microbes, the bacillus tuberculosis secretes a large 
amount of soluble products. These toxins, which of late years 
have been subjected to careful experiment, are derived from cul- 
tures of human bacilli, modified or not by aviary germs and the 
tuberculous products produced in the organism itself Koch's 
tuberculin, now known throughout the world, is simply a soluble 
product, prepared by a special process, consisting of a glycerized 
extract drawn from pure cultures of tubercle bacillus, its activity 
depending upon the virulence of the germs, those derived from 
man being more dangerous than aviary cultures. 

Various methods of inoculation have been adopted in tubercu- 
losis : I, inoculating the patient with another disease; 2, inocula- 
tion with attenuated tuberculosis or that proceeding from a different 
species, as from birds ; 3, inoculation of the soluble bacillar prod- 
ucts — tuberculin; 4, injection of blood taken from animals often 
immune against tuberculosis; 5, injection of serum drawn from 
inoculated animals ; 6, finally, injection of serum taken from 
immunized animals. With the last two of these methods we are 



SPECIFICS. 295 

properly concerned. The fifth has been scientifically adopted by 
Babes, Richard, and Hericourt, who have treated a large number 
of cases in which various cures have been effected. The main 
obstacle of the procedure lies in the difficulty of successful inocu- 
lation, the greater part of the animals employed dying of infectious 
nephritis. 

By the sixth method, as employed by Bernheim, this fatality is 
largely obviated, a careful procedure w^ith the serum of immunized 
animals proving the most efficacious hitherto devised. The pro- 
cess of immunizing consists in injecting the toxic products nor- 
mally secreted by Koch's bacillus, and is, in effect, that adopted by 
Behring in preparing the antitoxin of diphtheria. In experiment- 
ing upon a large number of animals, suffice it to say that the 
results obtained by Bernheim were eminently satisfactory, every 
case indicating improvement and the actual cures being about 40 
per cent. So convinced was he of the sovereign value of his 
method that he emphatically declared it to be the only rational 
procedure possible in tuberculosis : " Je puis meme affirmer que 
I'avenir de la therapeutique antituberculeuse reside tout entier dans 
cette maniere d'immuniser les animaux et d'utihser leur serum." 

AppHed to tuberculosis in man, there are as yet few signs of 
encouragement in the inoculation with the product of specific germs. 
The tuberculin of Koch has not responded to the hopes of its ad- 
vocates, the danger from untoward symptoms and relapse attending 
its use offsetting effectually any temporary benefit. Yet it is quite 
possible that the discovery of so powerful an agent may lead to 
others of more established efficacy. 

Pneumonia. — All the pulmonary symptoms which characterize 
this disease are produced by a single microbe, suspected by Klebs, 
described oy Koch and others, and discovered by Pasteur in the 
bucco-pharyngeal cavity, its habitual haunt, whence it carries in- 
fection to the lungs. The pneumococcus does not confine its 
attacks to man, the rabbit and guinea-pig being especially sensitive 
to its influence. It has been observed that the microbe is a fre- 
quent prey to leucocytosis. It thrives in a total absence of oxygen, 
its vitality and virulence, so far from diminishing, being sensibly 
increased by anaerobic conditions. Pure cultures are easily obtain- 
able. 

Repeated inoculations of attenuated virus readily confer immunity, 
reduction of virulent germs being attained by the use of desiccated 
pneumonic viscera. The saliva of a patient, collected after defer- 



296 A TEXT-BOOK OF MATERIA MEDICA. 

vescence, ensures protection to the mouse, the same being true of 
blood-serum. Immunization of animals was inaugurated by Em- 
merich and Fovitsky in 1891, subsequent investigators confirming 
their experiments under varying conditions, Foa and Scabia finally 
employing human serum in the inoculation of rabbits with marked 
success. 

It had been supposed that the spleen was the seat of an im- 
munizing product possessing greater activity, but a glycerized 
extract of human spleen injected into the veins of refractory rabbits 
failed to arrest death. The general deduction drawn from a care- 
ful scrutiny of the subject tends to prove that the production of 
the neutralizing force in the system — the antipneumotoxin — is 
shared by all the elements of the organism, including the spleen. 

The therapeutic interest of the subject centers in the application 
of inoculation to man. The early experiments of Foa and Scabia 
were without result, neither reaction nor amelioration attending 
their treatment; but in 1892, Klemperer reported favorably con- 
cerning immunization in 40 cases of human pneumonia. 

In January, 1893, Lava communicated to the Academy of Med- 
icine in Turin the application of serum-therapy with auspicious 
results. He inoculated 10 subjects — 5 with from 4 to 9 cubic cen- 
timeters of rabbit's blood-serum ; 4 with a like dose of glycerized 
extract of the viscera of immunized rabbits ; and I with from 4 to 
5 cubic centimeters of canine serum. There is no reaction at the 
point of inoculation, no general disturbance of the system, nor 
any influence upon temperature or respiration. On the contrary, 
the pulse is favorably influenced, as is also the general progress, as 
shown by Lava's experiments. Moreover, the injection hastens 
the crisis of the disease, conducing rapidly to complete restoration. 

Rozzolo also reported 5 cases treated with serum, 4 of which 
were cured. No influence upon the pulse, heart, or kidneys was 
noted. 

The effect of animal serum is fugacious ; that of the human 
product lasts several days. In all cases the serum of immunized 
subjects possesses a therapeutic but not an antitoxic power. It 
does not diminish the virulence of pneumococci, which, injected in 
an inoculated organism, retain their pathogenic activity about 
eighteen hours, after which, indeed, their vitality is manifested by 
the production of toxins producing positive chemotaxis in the 
phagocytes. 

Among other curative methods in pneumonia may be cited the 



SPECIFICS. 297 

hypodermic injection of blood taken from convalescents and the 
infusion of blood from similar patients. The former resulted fav- 
orably (Audeoud), and the latter (Hughes of Philadelphia), an 
intravenous operation, was no less successful. 

Audeoud explains the natural crisis in pneumonia by the theory 
of Klemperer — that the antipneumotoxin formed in the blood of 
an inoculated subject by neutralizing the pneumotoxin cures the 
infection. 

Cholera. — The microbe of this terrible disease had been sought 
since 1848, yet the subject had never been profoundly studied until 
Koch succeeded in isolating the germ. Being associated with 
other micro-organisms, the bacillus had remained undetected, being 
distinguishable, in fact, only in fulminant attacks of the disease, as 
was noted by Strauss and Roux. 

Stagnant water is particularly favorable to the propagation of 
germs. In distilled water the bacillus survives but twelve hours ; 
in drinking-water, seven days (Babes) ; while in river or well-water 
it may live for seven months (Wolfhiigel). As a rule, the acids are 
injurious to the bacilli, bichloride of mercury, sulphate of copper, 
and quinine being very powerful antiseptics in presence of the 
germs. 

Cholera has been observed in man alone, although Koch easily 
imparted the disease to guinea-pigs, to which it was fatal. Inocu- 
lation of choleraic virus has never produced the malady in man. 
The pathogenic power of the bacillus is well demonstrated by the 
fact that in one of the Berlin hospitals, of 207 patients attacked 
by cholera nostras (cholerine) in which no germ was manifest, 
but one case proved fatal ; and, notwithstanding vigorous oppo- 
sition, Koch's original thesis appears to be sustained by observation. 

A singular fact in connection with cholera germs is that they 
may be ingested at times, if not with impunity, at least without in- 
ducing the disease. Pettenkofer, having taken large doses of alkali, 
absorbed a considerable quantity of the poison with only the effect 
of a diarrhea during five days, there being no disturbance of the 
general system or of the kidneys. Emmerich, ingesting the tenth 
part of Pettenkofer's dose, was seized with diarrhea twenty-four 
hours afterward, and became seriously ill. Purging lasted four 
days, and on the eleventh day the bacilli disappeared from the 
stools. 

It were beside the purpose of the present work to relate in 
detail the many interesting experiments upon animals undertaken 



298 A TEXT-BOOK OF MA TERIA MEDICA. 

with a view to the apphcation of serum-therapy in the treatment of 
human cholera. Although the experimental investigations of 
recent years foreshadow the possibility of immunization in man, it 
must be confessed that, as in the case of tuberculosis, they have 
been thus far barren of definite results. It is announced that Behr- 
ing has discovered a practical method of combating the disease : 
until the results of his later researches are known the therapeutic 
problem must apparently remain unsolved. The result of Haff- 
kin's investigation in India will be awaited with interest. 

Septicemia. — The streptococcus of Fehleisen (erysipelatis),, 
which causes erysipelas, was discovered by Nepveu in France and 
Hiiter in Germany (1868-80), and has been the subject of careful 
study by Klemperer and others in the hope of determining its 
availability as an immunizing agent. Employing the serum of 
immunized rabbits, it has been found possible by intravenous injec- 
tion to cure the disease in mice, the serum proving efficacious only 
against the disease with which the animal supplying it was inocu- 
lated. Subsequent experiments have been attended with varying 
results, Marmoret in February, 1895, having succeeded in obtain- 
ing a germ of streptococcus so virulent that the hypodermic injec- 
tion of rooVo o" ^^ ^ cubic centimeter was fatal to the rabbit in thirty 
hours. Inoculation with this microbe or its toxins conferred im- 
munity upon rabbits, which furnished a preventive and curative 
serum. 

Encouraged by previous experimentation, Charrin and Roget 
now sought to apply the method of serum-therapy in the treat- 
ment of puerperal fever. Having satisfied themselves of the cura- 
tive property of the serum of a mule inoculated with the microbe 
of erysipelas, collected fifteen days after the eighth inoculation,, 
they injected subcutaneously 8 cubic centimeters of serum in a 
woman affected with the fever. The report is as follows : " The 
next day no improvement. A second injection of 8 cubic centi- 
meters. Next day condition slightly improved, but still serious. 
Third injection of 25 cubic centimeters. Result on the following 
day rapid improvement ; decline of fever ; general good health ; 
and early establishment of convalescence." 

Syphilis. — The pathogenic source of syphilis is still unknown. 
The disease being contagious, attempts have long been made to 
discover its specific microbe, yet th^ highest authorities agree that as 
yet all researches have proved abortive. No lower animal is known 
to be susceptible to the malady, and, although various experiments 



SPECIFICS. 299 

have seemed to prove the contrary, it is now determined that the 
lesions primarily indicating contraction of syphilis were the result 
of septicemia induced by some agent infected with the syphilitic 
virus. 

The sero-therapeutic methods employed in the treatment of the 
disease consist of inoculation with the blood of naturally immune 
or of syphilitic subjects. Of all animals, the horse is perhaps the 
only one capable of syphilization. 

Tommasoli in 1892-93 essayed inoculation of pubHc women, 
affected with acute secondary syphilis, with lamb's serum, the 
results being, according to his report, highly favorable — even to 
the cure of syphilitic infection. Many untoward symptoms, how- 
ever, have attended the inoculations thus made. Mozza (1893) 
instituted a series of experiments, employing blood from the carotid 
artery of a lamb or dog, and another series in which injections were 
made of serum drawn from sheep inoculated with serum from 
syphilitic subjects in whom the disease was latent. His records 
indicate no very satisfactory results, yet he demonstrated that 
aseptic precautions allow the application of serum-therapy without 
local or general reaction. 

Finally, Hericourt and Richet attempted, with dubious success, 
the experimental injection of syphilitic serum, the results, in their 
therapeutic importance, being inconsequential. 

Typhoid Fever. — The bacillus of this disease was first detected 
in the kidneys by Bouchard in 1879. The name was given by 
Eberth, who studied the germ in 1880-81. Old cultures contain 
an exceedingly toxic ptomaine, besides a soluble substance capable 
of inoculating animals. The vigor of the bacillus of Eberth is re- 
markable, Grancher and Deschamps having shown that it sur- 
vives five and a half months at a depth of 50 centimeters in damp 
soil. Infection may occur through the medium of the pulmonary 
tract, and the microbe is transmissible from the mother to the 
fetus. 

All animals yet submitted to experiment are naturally immune, 
the first effort to inoculate them dating from 1862 (Murchison); 
the attempt proved futile. Other experiments in this direction 
were attended with like failure until Vidal and Chantemesse suc- 
ceeded in inoculating with very virulent cultures 30 white mice, 17 
of which succumbed within twenty-four hours. 

Later experiments have proved the extreme virulence of serum 
derived from a typhoid human subject, fatality speedily resulting 



300 A TEXT-BOOK OF MA TERIA MEDIC A. 

from its injection, caused not by the microbe itself, since none are 
found after death, but by its toxic products. 

Among the phenomena observed in varied experimentation the 
inexplicable fact was revealed that the serum of certain persons 
never having contracted typhoid fever conferred immunity upon 
guinea-pigs. 

Casual experiments followed without favorable progress, other 
than the reduction of temperature. In January, 1895, however, 
M. Legrain, turning his attention to typhus — so closely aUied to 
true typhoid fever — met with encouraging success. Injecting suc- 
cessively increased doses of serum from typhus convalescents, 
besides the reduction of temperature within three hours after the 
operation it was noted that stupor, coma, and even hemiplegia of 
a toxic nature, disappeared after an injection of 10 cubic centimeters. 
In a case of grave typhus the injection of 14 cubic centimeters on 
the fourth day of the infection resulted in lowering the temperature 
and inaugurating recovery within two days. In other serious cases, 
where the injection was delayed until the sixth or eighth day of 
the infection's course, the disease, though not arrested, was marked 
by mitigated symptoms. The serum of convalescents was taken 
after one week's remission of febrile manifestations. 

Relying upon the fact that an attack of typhus confers immunity 
against a second access of the disease, Stern sought to ascertain 
whether the serum of individuals cured was endowed with immu- 
nizing properties. The results were partially successful, eliciting 
the curious fact that the protective power of the serum appeared 
most active in those who finally succumbed to the disease. It also 
seemed problematical, to judge from these and other instances, 
whether immunized serum employed in this disease possesses either 
bactericidal or antitoxic properties. 

Influenza. — Although the disease has occurred at intervals since 
the serious epidemic of 1830-33, the earliest microbiological studies 
of influenza date from the epidemic of 1889-90. Investigation at 
that time revealed no microbes in the sputum and viscera, save 
those which habitually frequent the bucco-pharyngeal cavity — 
streptococcus, pneumococcus, pneumo-bacillus, and staphylococcus 
— ^which diversity of germs might induce the belief that "la grippe" 
is not due to any single micro-organism, but to several. 

Notwithstanding this and similar suppositions, the majority of 
microbiologists maintain that these bacteria are but the result of a 
secondary infection, and that the true germ of influenza is still 



SPECIFICS. 301 

unknown, although many investigators have thought they had iso- 
lated the specific microbe. 

One deduction is constant as the result of their studies : the 
great importance of secondary infections in the course of the 
disease. 

Failure to discover the germ was in reality due to a deficiency 
of technique — inadequate methods of staining. Pfeiffer devised a 
new method, by which he detected it, and Kitasato (1892) suc- 
ceeded in isolating and cultivating the identical microbe. 

Animals do not contract the disease spontaneously, although 
the saliva of cats and dogs contains a bacillus having a pathogenic 
influence upon rabbits, the character of which closely resembles 
that of the Pfeiffer bacillus. Monkeys and rabbits contract the 
malady when inoculated with the pure culture of this germ. 

In man the port of entry, so to speak, of this microbe is the 
pulmonary tract, where it often produces lesions of suppurating 
broncho-pneumonia. The general phenomena observed in the 
disease are held by Pfeiffer to be the result of intoxication, the 
microbes being localized ; Cauch, on the contrary, considers them 
due to the presence of the microbe in all the organs, even the 
blood. The latest investigations confirm the opinion of Pfeiffer. 

Brischettini has demonstrated that the propagation of the Pfeiffer 
bacillus is not checked by the action of serum from immunized 
animals, being Hmited to diminishing the toxicity of its soluble 
products. The immunity caused by the injection of these products 
is augmented by the injection of the culture. 

The injection of serum of an immunized animal neutralizes 
in vitro the toxins secreted by the bacillus, and in a healthy organ- 
ism establishes immunity, whether against infection or intoxication. 
It is therefore assured that in future use the serum may be em- 
ployed at once as an inoculative and curative agent. 

Reptile Poisons. — It has long been known that certain animals 
(reptiles) possess natural immunity against their own venom. The 
poison of the toad having been detected in his blood, the reptile's 
immunity was at first thought to be due to tolerance, the same 
condition existing in the salamander and viper. 

The relation between the blood and the venomous glands demon- 
strates the internal secretion of these glands. The idea of an anal- 
ogy between microbic virus and reptilian venom was deduced from 
the existence of soluble microbic toxins, as elucidated by Chauveau. 
The attenuating power of heat upon the venom of serpents has 



302 - A TEXT-BOOK OF MATERIA MEDICA. 

also its analogue in the similar susceptibility of micro-organisms. 
A mortal dose of venom subjected for five minutes to a heat of 
1 00° C. may be injected with impunity into a guinea-pig weighing 
500 grammes. 

The reaction of the organism engenders an antitoxin which, in- 
jected into a healthy animal, is preventive of fatal inoculation. The 
precise nature of this antitoxin is undetermined, yet its protective 
power is evident. Certain it is that the serum of a rabbit inocu- 
lated against viperous venom, when injected an hour and a half 
before the poison, completely neutralizes the latter. Curiously 
enough, this preventive serum of rabbits inoculated against the 
poison of vipers also confers immunity against cobra- venom. 

So far as affects man, Calmetti announces that he has employed 
serum with success in the treatment of snake-bites, even to the 
extent of curing them. 

Carbuncle (Anthrax). — The bacterium of anthrax, of the genus 
bacillus, has proved a subject of elaborate and interesting experi- 
ment, many features of which are of absorbing interest ahke to the 
bacteriologist and the clinician. The animals subjected to inocula- 
tion have been chosen with great care, and those supplying the 
immunizing serum include many species. The general results of 
protective inoculation have been treated briefly early in the discus- 
sion of serum-therapy. 

Rabies. — In January, 1881, Galtier announced that intravenous 
inoculation of rabid saliva confers immunity upon sheep, confirm- 
ing his experiments later in the year by injecting the fluid into nine 
sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller 
pursued experiments in a similar line, with somewhat negative 
results. 

By passing the virus successively from dogs to monkeys Pasteur 
was able to attenuate its virulence, and finally, by transferring the 
poison from monkeys to rabbits, a serviceable immunizing agent 
was obtained, still further experiments perfecting the method in 
view. 

Satisfied with his success, Pasteur now turned his attention to 
the inoculation of man against hydrophobia. The first operation 
(in 1885) was attended with auspicious results, and from that 
moment the savant's laboratory was invaded by affected individuals 
demanding cure. Institutes were founded in various parts of the 
world, that in Paris being the center of bacteriological study in 
France. In America the subject has received wide attention, but 



SPECIFICS. 303 

in many instances the benefits derived from Pasteur's inoculative 
procedure have been of doubtful importance among intelligent 
observers. 

With regard to the administration of serum, several precautions 
are of great importance. The absolute cleanliness of the syringe, 
for example, should be an object of especial care. To this end a 
glass barrel is preferable, in order that impurities may be readily 
detected and removed. For packing purposes rubber or asbestos 
should be employed, and the instrument should be so constructed 
as to permit cleansing and sterilizing of every part before and after 
use. 

The mode of injection and the amount of dosage (measured in 
antitoxin units) vary somewhat according to the nature of the dis- 
ease and the age and susceptibility of the patient. Care should be 
taken to use only the most reliable preparations. 

It has been impossible to present within a necessarily limited 
space the entire field covered by this profoundly interesting subject. 
For a multitude of details, embodying a wide range of experimen- 
tation, and for many expressions of individual opinion awakened 
by a consideration of so absorbing a theme, the student is referred 
to the extensive bibliography relating to every phase of serum- 
therapy. 

It may be readily imagined what would have been the discus- 
sion of Jenner's vaccination had our bacteriological and chemical 
knowledge and delicate appliances for investigation existed in his 
day. It is scarcely surprising, therefore, that the renewal of similar 
studies, after an interval of unprecedented scientific progress, should 
elicit from all parts of the world a zeal and enthusiasm impossible 
in any previous epoch, together with a mass of concurrent or dis- 
senting testimony touching new discoveries proportionate to the 
greatly increased number of competent investigators. Whatever be 
the limitations of serum-therapy, the consensus of opinion among 
thoughtful observers is that its importance to mankind and its pur- 
pose are deeply rooted in the eternal laws of matter and the 
methods of great Nature. Its rationale, its mysterious power, and 
startling phenomena awaken new and greater problems of bacterio- 
logical science ; yet, though the entire subject, embracing as it does 
so ample and momentous a field of inquiry, remains sub judice, the 
character of modern scientific investigation must surely reveal its 
truth or falsity. 



DIVISION III.— ANTISEPTICS. 



Acidum Carbolicum— Acidi Carbolici— Carbolic 
Acid. U.S.JP. 

Orig-in. — A constituent of Coal-tar, obtained by fractional distil- 
lation and subsequently purified. 

Description and Properties. — Colorless, interlaced, or sepa- 
rate, needle-shaped crystals, or a white, crystalline mass, some- 
times acquiring a reddish tint, having a characteristic, somewhat 
aromatic odor, and, when copiously diluted with water, a sweetish 
taste, with a slightly burning after-taste. Deliquescent on exposure 
to damp air. 

Soluble in about 1 5 parts of water, the solubility varying accord- 
ing to the degree of hydration of the acid ; very soluble in alcohol, 
ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and 
volatile oils. It is liquefied by the addition of about 8 per cent, 
of water. The vapor of the acid is highly inflammable. Carbolic 
acid is faintly acid to litmus-paper. It should be kept in dark 
amber-colored, well-stoppered bottles. 

Dose. — \-2 grains (0.03-0.12 Gm.). If Hquefied, 1-2 minims 
(0.03-0.12 Cc). 

Official Preparations. 

Glyceritum Acidi CarbSlici — Glyceriti Acidi Carb61ici — Glycerite of Car- 
bolic Acid (25 per cent.). — For external use. 

UnguSntum Acidi Carb61ici — UnguSnti Acidi Carbolici — Ointment of Car- 
bolic Acid (10 per cent.). — For external use. 

Unofficial Preparations. 

Aqua Acidi Carb61ici— Aquae Acidi Carb61ici— Carbolic Acid Water.— 

Strength, 2 drachms in i pint (8.0-473. 1 7 Cc). Dose, 1-2 fluidrachms (4.0-8.0 Co.). 

Oleum Acidi CarbSlici— Olei Acidi Carb61ici— Carbolated Oil.— i in 20 of 
Olive or Cotton Seed Oil. For external use. 

Carbasus Acidi Carb61ici— C^rbasi Acidi Carb61ici— Carbolic Acid Gauze. 
—Gauze containing Carbolic Acid, i ; Resin, 5 ; Paraffin, 7 parts. Used as a surgical 
dressing. 

304 



ANTISEPTICS. 305 

Empiastrum Acidi Carb61ici — EmplSstrum (ace.) Acidi Carb61ici — Car- 
bolic Acid Plaster. — Composed of Carbolic Acid, 25 ; Shellac, 75 ; coated with Gutta- 
percha dissolved in Carbon Bisulphide. For external use. 

Camphora Carbolisata — Camphorae Carbolisatse — Camphorated Carbolic 
Acid (Phenol-camphor). — Camphor, 2; Carbolic Acid, i ; allow to liquefy. A color- 
less, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, 
nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache. 

Liquor Sodii Carbolatus — Liquoris Sodii Carbolati — Phenol-Sodique. — 
Composed of Carbolic Acid, i"^"^ grains (12.5 Gm.) ; Caustic Soda, 31 grains (2.06 Gm.) 
Distilled Water, 4 ounces (118.29 Cc). For external use. 

Liquor Sodii Boratis Compositus — Liquoris Sodii Boratis Comp6siti — 
Dobell's Solution. — Composed of Borax and Sodium Bicarbonate, of each, 2 drachms 
(15.0 Gm.) ; Carbolic Acid, 24 grains (1.8 Gm.) ; in Water, i pint (473.17 Cc). Used 
externally in spray. 

Acidum Carbolicum lodatum (N, F.) — Acidi CarbSlici lodati — Iodized 
Carbolic Acid (Phenol Iodatum). — Composed of Iodine, 20 parts; Carbolic Acid, 
76 parts ; Glycerin, 4 parts. The iodine, the acid which has been previously melted, 
and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated 
until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark 
place. Used locally, especially in g}'necological practice. 

Allied ConipoiLuds. 

Creasols. — Obtained by distilling Coal-tar between 200° and 210° C. ; also obtained 
by fusing Toluene Sulphonic Acid with Potash. The famihar compounds of creasols 
are Crealin, Lysol, Solutol, Saprol, etc. They are powerful disinfectants and germi- 
cides, and less poisonous than carbolic acid. . Aseptol, or orthophenol-sulphonic acid, is 
a commercial article, a straw-colored, slightly caustic liquid. It is a powerful antiseptic. 



Antagonists and Incompatibles. — Bromine, metallic salts, 
antipyrine, collodion, alkalies, saccharate of lime or lime, and 
soluble sulphates like. Epsom or Glauber salts, are incompatibles. 
Atropine is a physiological antagonist. 

Synergists, — All members of the carbolic-acid group, antisep- 
tics, and motor depressants. 

Physiolog'ical Action. — Externally . — Carbolic acid is a local 
anesthetic, and^ applied in full strength to animal tissues, acts as a 
caustic, but does not produce vesication. In weaker solutions it 
produces a burning and reddening of the skin. It acts more 
severely upon mucous membranes. It coagulates albumin, and 
therefore its caustic action is limited. 

The eschar is first whitish, subsequently becoming brownish. It 
is readily absorbed through the skin or through raw surfaces, and 
toxic effects have been thus produced. Weak solutions are anti- 
pruritic and gratefully cooling and anodyne. It is a disinfectant, a 
deodorant, and a parasiticide. 



306 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — Digestive System. — In small doses it is cooling and 
sedative to the stomach. In large or poisonous doses it is a pow- 
erful gastro-intestinal irritant. Ordinary medicinal doses are con- 
verted by the gastric contents into the sulphocarbolates. 

Circtdatojy System. — Medicinal doses have no apparent effect 
on the circulation. Large doses first depress and later accelerate 
the heart. Poisonous doses powerfully depress the heart, stopping 
it in diastole. The arterial tension is lowered by lethal doses, from 
paralysis of the vaso-motor center in the medulla. 

Nervous System. — Medicinal doses have no special effect upon 
the nervous system. Large or poisonous doses depress the cere- 
brum. Vertigo may first be noticed, which is soon followed by 
stupor. Owing to stimulation of the anterior cornua of the spinal 
cord, there may be muscular trembhng or convulsions. The 
cornua are ultimately depressed, causing abolition of reflexes and 
paralysis. 

Respiratory System. — Small doses do not affect the respiration. 
Large doses first accelerate the respiratory movements, rendering 
them full, but shallow respirations soon follow. This action is due 
to stimulation of the vagi, both at the periphery and at the center. 
If the dose has been a poisonous one, there is great depression, 
and ultimately paralysis of respiration, due to depression of the 
centers. 

Absorption and Elimination. — It is absorbed from the stomach, 
and diffuses into the blood with great facility, circulating in that 
tissue probably as an alkaline carbolate. 

It is ehminated by all the secretions — chiefly by the kidneys 
and lungs — and appears in the urine as salts of sulphocarbolic and 
glycuronic acids, and the oxidated products hydrochinon and 
pyrocatechin. To the last substance is mainly due the peculiar 
smoky or olive-green color imparted to the urine after large or 
continued doses have been taken. (There is also, probably, some 
other factor causing this change, for pyrocatechin can exist only in 
alkaline urine.) 

When a very large amount of carbolic acid has been taken, 
some of it can be found in the urine unchanged. 

Temperature. — It is not specially affected by small doses. Full 
medicinal doses tend to lower bodily temperature in fever, while 
poisonous doses lower the temperature several degrees. The re- 
duction of temperature is due to its diminishing heat-production 
and increasing heat-dissipation. 



ANTISEPTICS. 307 

Eye. — Poisonous doses almost invariably cause the pupil to be 
minutely contracted, due, probably to paralysis of the radiating 
fibers, the circular fibers being unaffected. 

Untoward Action. — Headache, either in the frontal or the occip- 
ital region, heaviness and a sensation of fulness in the head, dizzi- 
ness, and the appearance of rings before the eyes, muscular weak- 
ness, especially of the legs, profuse sweating, formication. 

Where there is an idiosyncrasy on the part of the individual 
against this drug, small doses even may produce the symptoms of 
poisoning. 

Poiso7ti7ig. — Carbolic acid is one of the most deadly poisons, 
often equaUing hydrocyanic acid in its rapidity of action. 

The patient is rendered rapidly unconscious or may drop dead 
within a very few moments from paralysis of respiration. Should 
the dose be insufficient to produce so sudden a death, the patient 
suffers from all the symptoms of gastro-enteritis — intense pain, with 
violent vomiting and purging. Fibrillary trembling maybe present. 
Stertorous breathing appears, with cold, clammy skin, pinched face, 
anxious expression, abolition of reflexes, weak, thready, and often 
imperceptible pulse, feeble respiration, and frequently dyspnea, and 
death finally occurs from failure of respiration. 

As toxic symptoms may be produced by the external applica- 
tion of solutions of carbolic acid, as in surgical dressings or vaginal 
or intra-uterine douches, the toxicity of this drug should be appre- 
ciated, and patients carefully watched for the first untoward mani- 
festations, such as pain in the lumbar region, smoky urine, nervous- 
ness, and cerebral disturbance, when the drug should be immedi- 
ately withdrawn. 

Treatment of Poisoning. — The immediate administration of mag- 
nesium sulphate (Epsom salts) and warm demulcent drinks should 
be resorted to. The application of external heat. Atropine and 
strychnine hypodermically. Digitalis and coffee may also be re- 
quired. Opium, or some preparation of it, for the relief of pain. 
If the patient is seen soon after the drug has been taken, the stom- 
ach should be washed out, after which the above treatment should 
be followed. 

Therapeutics. — Externally and Locally. — For some time after 
it was so prominently brought forward by Lister carbolic acid was 
thought to be indispensable in antiseptic surgery. It is now 
known that the solutions which are safe to use are inefficient, 
ordinarily, beyond the mere mechanical effect of washing. 



3o8 A TEXT-BOOK OF MATERIA MEDICA. 

The benumbing influence produced on the hands of the sur- 
geon, and the discoloration of bright instruments and rapid impair- 
ment of their cutting surfaces, render strong solutions for disinfect- 
ing instruments impracticable, and indeed of less value for this 
purpose than the prolonged boiling in distilled water rendered 
slightly alkaHne with sodium bicarbonate. 

The pain of superficial burns is relieved by applying strong 
solutions of carbolic acid, care being taken to prevent absorption. 

It is an extremely valuable drug as an antipruritic, and is hence 
of great utility in the treatment of certain diseases of the skin — 
pruritus, chronic eczema. In chilblains, tinea tonsurans, t. capitis^ 
t. circinata, favus, etc. it is of great value. Chronic laryngitis, cha- 
racterized by diminished secretion, is greatly benefited by the direct 
application to the parts of a solution of \ drachm to i ounce of 
glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains 
(0.12-0.36 Gm.) to I ounce (30.0 Cc.) of water is an efficient appli- 
cation in the treatment of acute and chronic injlaininatio7i of the 
throat and nose. 

Camphorated carbolic acid (campho-phenique) is a useful appli- 
cation in toothache due to an exposed and inflamed pulp. 

As a deodorant it is valuable to correct the fetor arising from 
syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchorrhea, 
pnetmiothorax, etc. 

It reduces the discharge and relieves the pain in acute otitis 
media: a 10 per cent, solution in glycerin should be used. It is 
also of value in the treatment of otorrhea and in acute perforations 
of the tympanic membrane , but should be used in much weaker 
solutions — I or 2 per cent. 

A lotion, 8 to 15 grains (0.5-1.0 Gm.) to i ounce (30.0 Cc.),. 
is an efficient antiseptic in fotil and indolent ulcers. 

The pure acid is used as a cauterant in chancroids, lupus, gan- 
grene, bites of rabid animals, etc. 

The iodized carbolic acid is a valued local remedy in endometri- 
tis, chronic endo cervicitis, and tdcers of the cervix. 

Hiiter in 1878 advocated the use of hypodermic injections of 
a 3 per cent, solution of carbolic acid for erysipelas, the punctures 
to be made at intervals upon the edge of the inflammation. 

Great improvement has taken place in goitre after the treatment 
by hypodermic injections into the tumor of a 5 per cent, solution 
of carbolic acid. 

Internally. — While inferior to salicylic acid to check fermentation,. 



ANTISEPTICS. 309 

it is nevertheless used for that purpose in dilatation of the stoviacli 
and so-called fermentative or flatulent dyspepsia. 

In nervous and irritative vomiting it may be given in doses of 
from I to 2 minims (0.06-0. 1 2 Cc), well diluted and repeated at 
intervals of from one to four hours according to the symptoms 
of the case. 

It has been used in acute and chronic dysentery, and as an anthel- 
mintic against ascarides and tcEiiia solium. 

It has also been advocated as a remedy for typhoid fever and in 
malarial cacJiexia, but purely upon theoretical grounds, no clinical 
results having thus far justified its use in these disorders. 

Administration. — It may be given internally in pills or capsules, 
mixed with powdered liquorice-root as an excipient, or dissolved in 
glycerin and well diluted with sweetened water. 

For external use various strengths are used (from 1:10 to 
I : 500), and the various preparations mentioned may be used 
according to the case and indications. 

Sodii Sulphocarbolas— Sodii Sulphocarbolatis— 
Sodium Sulphocarbolate. TJ, S. P. 

Description and Properties. — Colorless, transparent, rhombic 
prisms, odorless, having a cooling, saline, sHghtly bitter taste. 
Somewhat efflorescent in dr^^ air. Soluble in 4.8 parts of water, 
132 parts of alcohol, 0.7 part of boiUng water, and in 10 parts of 
boiling alcohol. The aqueous solution is neutral to litmus-paper. 

Dose. — 10-30 grains (0.60-2 Gm.). 

Allied Compounds. 

Potassii Sulphocarbolas — Pot^ssii Sulphocarbolatis — Potassium Sulpho- 
carbolate. 

Caicii Sulphocarbolas — C^lcii Sulphocarbolatis — Calcium Sulphocarbolate. 

Magnesii Sulphocarbolas — Magnesii Sulphocarbolatis — Magnesium Sul- 
phocarbolate. 

Zlnci Sulphocarbolas — Zincii Sulphocarbolatis — Zinc Sulphocarbolate. 

All of the above have been employed, but the zinc sulphocarbolate is believed to be 
preferable to check diarrhea and render the stools less foul. It is best given in pills, in 
doses of 2-3 grains (0.I-0.15 Gm.). 

Physiolog-ical Action. — In medicinal doses sodium sulphocar- 
bolate occasions no special symptoms, and in three or four times 
the medicinal dose it causes only slight lightness of the head. 

It is changed in the system into carbolic acid and sodium sul- 



3IO A TEXT-BOOK OF MATERIA MEDIC A. 

phate, the latter being eliminated with the urine. The carbolic 
acid set free exerts its characteristic action and influence. 

Therapeutics. — Externally and Locally. — In the strength of 
\ drachm (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a 
valuable gargle in relaxed conditions of the throat. 

Solutions of different strengths have been used in diphtheria^ 
acute tonsillitis, aphthce of children, and nasal catarrh. 

30 grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and 
hydrogen peroxide make an efficient injection in gonorrhea. 

Internally. — It is a mild intestinal antiseptic, and may be used 
internally for the same purposes as carbolic acid in such disorders 
as diarrhea, fermentative dyspepsia, etc. It arrests the growth of 
thrush, and is considered by some physicians to exert a favorable 
action in anginose scarlatina, diphtheria, and typhoid fever. The 
ZINC SULPHOCARBOLATE is One of the best intestinal antiseptics to 
use in cases of dyspeptic diarrhea of children. 

Administration.- — Sodium sulphocarbolate is best given in 
solution. 

Creosotum—Creosoti— Creosote. JJ. S. T, 
Origin. — A mixture of phenols, chiefly Guaiacol and Creosol, 
obtained during the distillation of wood-tar, preferably that of beech. 
Description and Properties. — An almost colorless, yellowish 
or pinkish, highly refractive, oily Hquid, having a penetrating 
smoky odor, and a burning, caustic taste ; usually becoming darker 
in tint on exposure to light. Soluble in about 150 parts of water, 
but without forming a perfectly clear solution. With 1 20 parts of 
hot water it forms a clear liquid which on cooling becomes turbid, 
from the separation of minute oily drops. Soluble in all propor- 
tions in absolute alcohol, in ether, chloroform, benzin, carbon disul- 
phide, acetic acid, and in fixed and volatile oils. Creosote is in- 
flammable, burning with a luminous, smoky flame. It is neutral, 
or only faintly acid, to litmus-paper. 

Tests. — Carbolic acid is often substituted for creosote, and the 
following tests for the detection of carbolic acid are important : 

1. If the suspended liquid is mixed with collodion, a coagulum 
will form if carbolic acid be present. 

2. Carbolic acid produces a violet color with ferric chloride and 
ammonium hydrate, creosote producing a green color passing to 
brown. 

Dose. — 1-5 minims (0.06-0.3 Cc). 



ANTISEPTICS. 311 

Official Preparation. 

Aqua Creosoti — Aquae Creosoti — Creosote Water. — Dose, 1-4 fluidiachms 
(4.0-15.0 Cc). 

Incompatibles. — Strong sulphuric and nitric acid. It reduces 
silver salts, and explodes when combined with oxide of silver. 

Synergists. — The same as for carbolic acid. 

Physiolog'ical Action. — Externally. — It has the same action as 
carbolic acid. 

Internally. — Its action upon the digestive, circulatory, nervous, 
and respiratory systems is practically the same as that of carbolic 
acid. 

It does not stimulate the spinal cord so much as carbolic acid, 
and differs also from the latter drug in increasing the coagulability 
of the blood. Poisonous doses act Hke those of carboHc acid, but 
with more marked nervous symptoms. 

Absorption and Elimination. — It is eliminated by the bronchial 
mucous membrane, and by the kidneys as guaiacol sulphate and 
creosol sulphate of potassium. 

It is a stimulant expectorant. 

It has the peculiar property when applied to meat of preserving 
it, whence its name {creas, flesh, sohzote, preserve). 

Poisoni?tg. — The symptoms and treatment of poisoning from 
creosote are the same as described under Carbolic Acid. 

Therapeutics. — Externally and Locally. — Creosote is superior 
to carbolic acid as an antipruritic, although not so generally used 
as the latter, on account of its acrid and penetrating odor. It can 
be used externally for the same purposes as carbolic acid. It is a 
valuable hemostatic, and the creosote water may be used for this 
purpose. 

Inhalations of creosote are recommended in phthisis, chronic 
bronchitis, and chro7tic congestion of the larynx and trachea. It is a 
powerful local anesthetic, and is largely used by dentists and the 
laity for aching teeth. It is used to preserve dead animal matter 
for dissection, etc. 

Internally. — Creosote can be used internally for the same pur- 
poses as carbolic acid, having the advantage over the latter drug in 
being one of the most efficient remedies in pidmonary tuberculosis. 
Probably no one remedy exerts so favorable an action upon the 
night-sweats, cough, and expectoration as creosote, or guaiacol, 
which is preferred by many physicians. It is of less value in cases 



312 A TEXT-BOOK OF MATERIA MEDICA. 

accompanied by high temperature and hemoptysis, and often 
aggravates these symptoms. 

It must be remembered that many oi the cases alleged to have 
been cured by creosote have been treated with cod liver oil, tonics, 
and hygienic methods as well. 

Contraindications. — The same as for carbolic acid. 

Administration. — Pure beech-wood creosote alone should be 
used. It may be given in the form of creosote water, emulsion, or 
pills, or in capsules mixed with cod liver oil. Capsules are the 
least offensive way of administration. Some persons prefer to take 
the drug in milk. 

In the treatment of phthisis large doses are necessary. A tol- 
erance can usually be established by gradually increasing doses. 
If the patient manifest any untoward symptoms, the drug must be 
reduced in quantity or discontinued altogether. 

Guaiacolum— Guaiacoli— Guaiacol. 

Orig-in. — As before stated, creosote consists chiefly of Guaiacol, 
Creosols, and Cresols, and of these guaiacol is present to the extent 
of from 60 to 90 per cent. 

Guaiacol is obtained by fractional distillation of beechwood-tar 
Creosote, treated with Ammonia to remove acid compounds, and 
again fractionated. 

Guaiacol is rarely met with absolutely pure. 

Description and Properties. — A colorless, slightly refractive 
liquid, of strongly aromatic odor. Specific gravity at 15° C. 
(59^ F.) is I.I 17. Sparingly soluble in water, but readily soluble 
in alcohol and ether. It is soluble in solutions of sodium and 
potassium hydroxides, forming unstable compounds known as 
sodium- and potassium-guaiacol. 

Tests. — Pure guaiacol will separate rapidly if shaken with twice 
its weight of benzene, whereas the impure article forms a clear 
solution. 

" If a trace of ferric chloride is added to an alcoholic solution 
of guaiacol, a blue color is developed, which changes to emerald- 
green upon the addition of more ferric chloride." 

Dose. — 2-10 minims (0.12-0.6 Cc). 

The following derivatives have been introduced : 

Guaiacoli BSnz-oas — Guaiacoli Benzoatis — Guaiacol Benzoate (Benzosol). 
— Origin, by heating on a water-bath Potassium Guaiacol with Benzosol-chloride : the 
impure benzosol-guaiacol formed is purified by reciTstallization from Alcohol. 



ANTISEPTICS. 313 

Description and Properties. — Colorless, tasteless, and odorless crystalline powder, 
almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol. 

Dose. — 10-150 grains (0.60-10 Gm.) daily. 

Guai^coli Carbonas — GuaiScoli Carbonatis — Guaiacol Carbonate. — Origin, 
this substance is prepared by passing Phosgene Gas (carbonyl chloride) into Guaiacol 
previously dissolved in soda solution. The guaiacol carbonate is formed and is purified 
and crystallized from Alcohol. 

Description and Properties. — White, neutral, crystalline powder, nearly void of odor 
and taste, insoluble in water, slightly soluble in cold and readily soluble in hot alcohol, 
also in ether, chloroform, and benzene, and sparingly soluble in glycerin and fixed 
oils. 

Dose. — 3-60 grains (0.2-4 Gm.) daily, gradually increased, 

Guaiacoli Di-iodidum — Guaiacoli Dl-iodidi — Guaiacol Diodide. — Origin, 
"by adding a solution of Iodine in potassium iodide to an aqueous solution of Sodium- 
guaiacol as long as precipitation continues. 

Description and Properties. — Reddish-brown salt, having the odor of iodine, soluble 
in alcohol and fixed oils, and readily decomposed. 

Dose. — 2-15 grains (o.io-i Gm.). 

Guaiacoli Salicylas — GuaiScoli Salicylatis — Guaiacol Salicylate (Guaiacol- 
■salol). — Origin, by the action of Phosphorous Oxychloride on a mixture of Sodium- 
guaiacol and Salicylate. It is analogous to salol. 

Description and Properties. — White, crystalline, odorless, and tasteless powder, in- 
soluble in water, but soluble in alcohol, ether, and chloroform. 

Dose. — 10-150 grains (0.60-10 Gm.) daily. 

Physiolog'ical Action of Guaiacol and its Derivatives. — 
Guaiacol produces an action very similar to that of creosote. It is 
not caustic when applied in full strength. It possesses marked 
■antipyretic properties. It is readily absorbed through the unbroken 
skin, and rapidly reduces febrile temperature when applied in this 
manner. The reduction of temperature lasts from four to six 
hours. 

It is a diaphoretic and diuretic. It is excreted by the sweat, 
saliva, and urine, but is only slightly thrown out by the expired 
air, though small amounts of the drug have been found in the 
lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it 
must combine with albuminous bodies in the blood, and chiefly 
through the sulphur present in the albumin molecules. It can be 
found in the urine within fifteen minutes after administration or 
external application in the form of a substance giving the reaction 
of phenol. 

It is more agreeable to the stomach than creosote, and fre- 
quently improves the appetite, though to some patients it is very 
disagreeable and acts as an irritant. 

The GUAIACOL CARBONATE is usually much better borne by the 
stomach, and is therefore a useful and efficient substitute. 



314 ^ TEXT-BOOK OF MATERIA MEDICA. 

Benzosol, guaiacol benzoate, contains 54 per cent, of guaia- 
col. It is usually well borne by the patient, and seldom occasions 
any digestive disturbance. In the intestinal canal it resolves into 
guaiacol and benzoic acid, and is excreted by the urine as combi- 
nations of these substances. 

Therapeutics. — Guaiacol is used for the same purposes as 
creosote — less likely to irritate the intestinal canal and kidneys. 

Guaiacol causes a marked reduction of the temperature in cases 
of tubercular disease when applied locally, nor is the antipyretic 
action when thus employed confined to tuberculous cases. It has 
given satisfactory results in other pyrexias. It is a very active 
antipyretic in erysipelas. The temperature begins to fall within 
fifteen or twenty minutes after the application of the drug. As 
with all antipyretics, the depressing action of guaiacol must be 
borne in mind. 

Raymond first suggested the local appHcation of guaiacol 
in tonsillitis. It undoubtedly exerts a favorable action on the 
disease. 

Guaiacol, or some one of its derivatives, has been substituted 
for creosote in the treatment of phthisis and other wasting forms 
of tuberculosis. Guaiacol itself has no advantage over creosote. 
The BENZOSOL and guaiacol carbonate possess the only advan- 
tage of being tasteless. 

Piatkowski of Vienna recommends benzosol in diabetes mellitus. 
There have been conflicting reports regarding its efficacy, yet suf- 
ficient is known in its favor to justify a further trial of this drug in 
diabetes. 

Contraindications. — The same as for creosote. 

Administration. — The application of guaiacol for the reduction 
of temperature may be made upon any portion of the skin — the 
back, breast, arms, thighs, or abdomen — without causing any appre- 
ciable difference. From \ to i drachm (2.0-4.0 Cc.) is applied 
with a brush, and the part covered with cotton or gutta-percha 
tissue. The application may be repeated as often as necessary for 
the reduction of the fever. 

Other than a decided taste of guaiacol and free diaphoresis, the 
patient usually complains of no untoward symptoms, although in 
some cases quite marked nervous disturbances and other unfavor- 
able manifestations have been observed. 

It may be inhaled from hot water for certain conditions in doses 
of from 5-10 minims (0.3-0.6 Cc). 



ANTISEPTICS. 315 

The solid derivatives of guaiacol may be given in powders or 
capsules. Guaiacol itself may be given in the same manner as 
creosote — preferably, mixed with cod liver oil or enclosed in cap- 
sules. 

Acidum Salicylicum— Acidi Salicylici— Salicylic 
Acid. L.S.B. 

Origin. — An organic acid, existing naturally in combination in 
various plants like Spircea iilinaria (meadow-sweet), GaultJicria 
pvocunibeiis (wintergreen), etc., but chiefly prepared synthetically 
by combining the elements of pure Carbolic Acid with dry Car- 
bonic Acid and purifying. 

Description and Properties. — Light, fine, white prismatic 
needles, or a light white cr}.^stalline powder, odorless, having a 
sweetish, afterward acrid taste ; permanent in the air. It is soluble 
in about 450 parts of water, in 2.4 parts of alcohol, and in 14 parts 
of boiling water. The addition of 2 parts of sodium sulphite or 
I part of ammonium phosphate renders it much more soluble in 
water. 

Test. — The addition of ferric chloride to a saturated solution 
produces a fine bluish-violet color. 

Dose. — 3-60 grains (0.25-4.0 Gm.). 

Lithii Salicylas— Lithii Salicylatis— Lithium Salicy- 
late. JJ. S. JP. 

Orig-in. — Obtained by heating Salicylic Acid, Lithium Carbonate, 
and Water until effervescence ceases, filtering, and evaporating. 

Description and Properties. — A white or grayish- white pow- 
der, odorless, having a sweetish taste, dehquescent on exposure to 
air, very soluble in water and alcohol. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Sodii Salicylas— Sod ii Salicylatis— Sodium Salicy- 
late. r.s.i>. 

Origin. — Prepared by acting on Sodium Carbonate with Salicylic 
Acid, straining, and heating the solution. 

Description and Properties. — A white amorphous powder, odor- 
less, sweetish, saline taste, permanent in air, soluble in 0.9 part of 
water, in 6 parts of alcohol, and in glycerin. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 



3i6 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists and Incompatibles. — The arterial and cerebral 
stimulants are antagonistic to salicylic acid and the salicylates. 
The incompatibles are the mineral acids, alkalies, metallic salts, 
particularly the ferric salts. 

Synergists. — The carbolic-acid derivatives, anesthetics, cardiac 
depressants, and cerebral sedatives. 

Physiological Action. — Externally and Locally. — Salicylic acid 
is antiseptic, parasiticide, irritant to mucous membranes ; possesses 
the power to soften the epidermis ; checks perspiration when locally 
applied (anhydrotic). 

htternally. — Digestive System. — Small doses stimulate the stom- 
ach ; larger doses act as an irritant. It is an antiferment. 

Circulatory System. — Small doses of salicyHc acid have no very 
appreciable effect upon the circulation. Full medicinal doses first 
cause the heart to beat faster and stronger, increasing arterial 
tension ; later the arterial pressure is lowered, and excessive or 
toxic doses cause the pulse to become slow and labored. Its tend- 
ency ultimately, even in medicinal doses, is to depress rather than 
stimulate the heart. Its effect upon the blood is to restrain the 
migration of the white corpuscles. 

Nervous System. — In toxic doses, and in some susceptible per- 
sons in full medicinal doses, salicylic acid causes cerebral conges- 
tion, indicated by a feeling of tension in the cerebrum, headache, 
confusion of thought, tinnitus aurium, vertigo, and sometimes 
delirium. Toxic doses may occasionally produce cerebral con- 
vulsions. It lessens the reflexes, but does not affect the peripheral 
nerves, either motor or sensory. 

Respiratory System. — Small doses stimulate the respiratory cen- 
ter and the pulmonary vagi, making the respiration quicker and 
deeper. Toxic doses paralyze the center and vagi, causing slow 
and labored respiration and death from asphyxia. 

Absorption and Elimination. — Salicylic acid is converted by the 
gastro-intestinal secretions into the sodium salicylate, in which form 
it enters into the circulation. 

It increases the urinary flow. It appears in the urine as sali- 
cyluric acid. The color of the urine is changed to a dark olive- 
green after large doses have been taken. This change is due 
to the presence of indican and pyrocatechin, produced by the 
action of the pancreatic juice upon the salicylic acid in the 
intestine. 



ANTISEPTICS. 317 

It is a powerful diaphoretic, large doses often causing exhaust- 
ing sweating. It also increases the secretion of milk and the 
amount of sugar in that secretion. 

Elimination takes place slowly by all the emunctories, but 
chiefly through the kidneys and skin. 

Teuiperatiirc. — Febrile temperature is markedly reduced by large 
doses of salicylic acid. The reduction takes place usually within 
half an hour after a dose has been taken, and lasts several hours. 
The antipyretic action varies in degree according to the cause of 
the pyrexia and the individual susceptibility of the patient. The 
reduction of temperature is produced by lessening heat-production 
and increasing heat-dissipation. 

Untoward Action. — Erythema, urticaria, or petechiae, accom- 
panied by intense itching, occasionally edema of the eyelids and 
lower extremities, mental depression, muscular weakness, motor 
disturbances, sweating, and buzzing in the ears, as mentioned under 
Poisoning, but to a less degree. 

Poisoning. — There are roaring in the ears, deafness, intense 
headache, vertigo, and possibly dehrium, profuse and exhausting 
sweating, subnormal temperature, very weak, compressible pulse, 
feeble and shallow respirations, dimness of vision, ptosis, and often 
strabismus. The blood is disorganized, and the corpuscles rapidly 
break down. The urine and feces pass involuntarily. Death 
usually results from respiratory failure. 

Treatment of Poisoning. — Diffusible stimulants, atropine, strych- 
nine — the same treatment as in poisoning by acetanilid. 

Therapeutics. — Externally and Locally. — Salicylic acid has 
been satisfactorily employed, in the strength of J to i drachm in I 
ounce (2.0 to 4.0 in 32.0 Gm.) of cosmoHne, in the treatment of 
erysipelas. 

In the treatment of chancroid salicylic acid has been extensively 
employed. The powdered acid should be thoroughly dusted over 
the surface. 

The peculiar action of salicylic acid in softening and loosening 
thickened masses of epidermis and favoring the normal prolifera- 
tion of epithehum renders the drug especially useful in the treat- 
ment of indurated eczema, particularly of the palm and sole, ver- 
ruca, tylosis, callositas, corns, zvarts, etc. 

It is one of the most useful drugs in the different varieties of 
eczema, impetigo contagiosa, psoriasis, Inpiis, parasitic affections, and 
in non-parasitic sycosis it has been employed by Heitzmann with 



3i8 A TEXT-BOOK OF MATERIA MEDICA. 

marked success. It has been used successfully in the treatment 
of acne^ comedones^ and pruritus. A 3 per cent, solution has been 
recommended in aspergillus of the outer auditory meatus. A 
wash, 3 grains to i ounce (0.2 to 30.0 Cc.) is efficient in otorrhea. 
Solutions of various strengths are frequently useful in acute coryza^ 
diphtheria, inflammation of fauces, catarrhal stomatitis, and to cor- 
rect ojfensive expectoration, especially in phthisis and gangrene of the 
lung. 

Internally. — There is no better example of empiricism in thera- 
peutics than the employment of salicylic acid in acute articular 
rheumatism. Used at first in this disease to reduce temperature, 
it was found that while it exerted marked antipyretic action, it also 
lessened the pain and swelling, and in the majority of cases short- 
ened the duration of the disease. It cannot be classed as a 
" specific " in any sense of the word, but merely relieves certain 
symptoms — fever, pain, and swelling. Other symptoms — or com- 
plications, according to some authors — such as heart affections, are 
uninfluenced by this medicine. Indeed, when so-called cardiac 
complications exist salicylic acid is certainly contraindicated. It 
has no power to prevent either affections of the heart or relapses. 
In the author's opinion, it is doubtful if salicylic acid alone is equal 
to the alkaline treatment or greatly superior to acetanilid or anti- 
pyrine. 

Rheumatic tetanus, irido-choroiditis , and sclerotitis are alleged to 
have been cured by this drug. It is useless in gout, according 
to the best Enghsh authorities, and is of no value in chronic or 
gonorrheal rheumatism, rheumatic arthritis, or rheumatic hyper- 
pyrexia. 

It is credited with being quite efficient in chorea of rheumatic 
origin, and in relieving the pains of herpes zoster and neuralgic 
headache. 

It is a drug to be tried in many diseases of rheumatic origin, 
unless some distinct contraindication to its use exists. It surpasses 
any drug, with the possible exception of guaiac, in the treatment 
of gtdnsy, and particularly rheumatic tonsillitis. The medicine is 
highly regarded by competent advocates as a remedy in diphtheria. 
Lumbago often yields to its influence, and it has also been recom- 
mended in sciatica, although in Cook County Hospital the author 
has seen a great number of cases of the latter treated with salicylic 
acid without any apparent improvement. He also regards it as 
valueless in typhoid and intennitteitt fevers. 



ANTISEPTICS. 319 

It is a useful antizymotic to prevent putrefactive fermentation 
and fiatiilejice, and lessen thereby the tendency to crapulous diar- 
rhea. 

Owing to the similarity of its action to that of quinine, it has 
been used, and with some success, in periodical 7ieuralgias which 
have not responded to the latter drug. 

It has been found of use in influenza, and is an efficient anti- 
septic remedy in clironic gastric catarrli, dianliea, cholera, and 
entero-colitis. By some eminent clinicians it is considered to be 
one of the most effectual remedies in pleurisy with effusion. 

It has been recommended as an effectual anthelmintic, both for 
tape- and round-worms. 

Contraindications. — Salicylic acid should not be given in large 
doses to persons who have a weak heart or are otherwise greatly 
debilitated, at least not without counteracting its toxical tendencies 
with nutrients and diffusible stimulants. 

Administration. — Owing to its irritant action upon the mucous 
membranes, it is best given in a solution of glycerin and some aro- 
matic water, after meals. So concentrated a form as a pill or cap- 
sule is not recommended. 

Many of the untoward cerebral effects may be relieved by giving 
20 grains (1.3 Gm.) of sodium or potassium bromide. 

Many of the toxical effects have been attributed to an impurity 
in the manufactured acid. 

If any benefit is to be derived from salicylic acid in acute artic- 
ular rheumatism, it must be used early in the disease and in heroic 
doses at comparatively frequent intervals — not less than 20 grains 
(1.3 Gm.) every two, three, or four hours for an adult. If too 
serious gastric and cerebral symptoms manifest themselves, the 
drug may be decreased in amount or discontinued until the 
unpleasant action subsides. 

It is better, except in acute articular rheumatism, to give a 
small dose, repeated frequently, than to administer a full dose at 
once. 

The physiological action and therapeutics of lithium salic- 
ylate are practically the same as those of sahcyhc acid or sodium 
salicylate. It is, however, richer in salicylic acid than the sodium 
salt, and in gout and chroriic rheumatism has been found to be of 
more value than sahcylic acid. 

It should be given in solution. 

Sodium salicylate is identical in physiological action and 



320 A TEXT-BOOK OF MATERIA MEDICA. 

uses with salicylic acid, with the exception that it is less irritating 
to the stomach, and is therefore ordinarily to be preferred to the 
acid. 

It may be prescribed in aromatic water, in syrup, or in powder, 
pills, or capsules. 

Salol— Salol— Salol. U. S. ^. 

(Phenyl Salicylate.) 

Origin. — The SalicyHc Ether of Phenol, prepared by heating 
Salicyhc Acid with Phenol in the presence of Phosphorus Penta- 
chloride. 

Description and Properties. — A white, crystalline powder, 
odorless, or having a faintly aromatic odor, and almost tasteless. 
Permanent in the air. Almost insoluble in water ; soluble in lo 
parts of alcohol ; also in 0.3 part of ether, and readily in chloro- 
form and in fixed or volatile oils. 

Dose. — 3-15 grains (o.i 9-1.0 Gm,). 

Physiological Action. — Externally and Locally. — It is a more 
powerful antiseptic than either of its constituents. Nencki claims 
that it is not a germicide, as it will not destroy bacteria when 
present, although it prevents their formation. It is not, Hke saH- 
cylic acid, irritating to the mucous membranes. 

Internally. — The action of salol is essentially like that of salicylic 
acid, but it is a more powerful antipyretic, analgesic, and cerebro- 
spinal sedative. It reduces temperature much more promptly, the 
antipyretic action occurring within fifteen minutes after a full medi- 
cinal dose has been taken. The effect, however, is not prolonged, 
repeated doses being required to maintain the reduction of tem- 
perature. 

The circulation is, perhaps, not so much depressed as by sali- 
cylic acid. The respirations are at first quite rapidly increased, and 
are rendered very shallow, requiring some time to resume their 
normal condition. 

It is converted by the pancreatic and intestinal juices into its 
original constituents — salicylic acid and carboHc acid. It is usu- 
ally absorbed and eliminated very rapidly, having been detected 
in the urine in the form of sahcyluric acid and phenol-ether-sul- 
phuric acid within thirty minutes after its ingestion by the stomach. 
To the latter acid is due the dark, smoky color of the urine which 
sometimes exists under large or continued doses of salol. 

Therapeutics. — Externally and Locally. — Salol is especialljr 



ANTISEPTICS. 321 

recommended as an antiseptic dressing for wotmds, burns, venereal 
ulcers, and buboes. Powdered salol or an ointment — i part to 150 
parts of petrolatum — has been used in cases of tubercular laryngitis 
and ozena. Like salicylic acid, it is also of value in eczema and 
sycosis simplex. 

Internally. — It is an efficient remedy in all diseases benefited by 
the internal administration of salicylic acid. In addition to these 
services it is a valuable remedy in acute and chronic cystitis, gonor- 
rhea, intestinal catarrh, especially duodenal catarrh and catarrhal 
jaundice, and to relieve the pains of 7ieuritis and myalgia. 

Salol is much more useful than salicylic acid in diarrhea, cholera 
moi'bus, and cholera, the latter disease yielding better, perhaps, to 
this remedy than to any other. 

Administration. — It may be given in pills, capsules, powders, 
emulsion, or suspended in milk. The compressed tablets of this 
drug so extensively used at present are not recommended, owing 
to their slow and difficult solution. 

SalicTnum— Salicini— Salicin. JJ, S. P, 

Origin. — A Glucosid obtained from several species of Salix 
(willow) and Populus (poplar). 

Description and Properties. — Colorless or white, silky, shining, 
crystalline needles, or a crystalline powder, odorless and having a 
very bitter taste. Permanent in the air. Soluble in 28 parts of 
water, 30 parts of alcohol, 0.7 part of boiling water, and in 2 parts 
of boiling alcohol. 

Dose. — 10 grains-2 drachms (0.6-8.0 Gm.). 

Physiolog-ical Action. — Its physiological effect is analogous to 
that of salicylic acid, but is much less active than the latter. It 
does not disturb digestion, but in moderate doses promotes appe- 
tite and acts like other bitters. It is more rapidly absorbed than 
salicylic acid, is partly decomposed, and is found in the urine, as 
salicin and saHcyHc acid, in from fifteen to thirty minutes after the 
ingestion of a single dose. 

Therapeutics. — While inferior to salicylic acid in most respects, 
salicin is frequently used for the same purposes. It is superior to, 
and safer than, salicylic acid in acute rheumatism characterized by 
a weak heart and depressed vaso-motor system. 

It is an excellent stomachic tonic, and may be used like other 
bitters in the treatment of atonic dyspepsia and other conditions 
benefited by this class of drugs. 
21 



322 A TEXT-BOOK OF MATERIA MEDICA. 

Contraindications. — In acute inflammatory affections of the 
brain and ear. 

Administration. — Salicin may be administered in powders, cap- 
sules, or solution. Owing, however, to its bulk and intensely bitter 
taste, it is perhaps best given in suspension in the aromatic elixir 
of Hquorice or in syrup of yerba santa. 

NaphtalTnum— Naphtalini— Naphtalin. TJ. S. JP. 

Origin. — A hydrocarbon obtained from coal-tar. 

Description and Properties. — Colorless, shining, transparent 
laminae, having a strong, characteristic odor resembling that of 
coal-tar, and a burning, aromatic taste ; slowly volatiHzed on expo- 
sure to air. Insoluble in water, but when boiled in it imparting a 
faint odor and taste. Soluble in 15 parts of alcohol, and very 
soluble in boiling alcohol ; also very soluble in ether, chloroform, 
carbon disulphide, and in fixed or volatile oils. Naphtalin vola- 
tihzes slowly at ordinary temperatures, but rapidly when heated. 
Its vapor is inflammable, burning with a luminous and smoky 
flame. It should be kept in well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Naphtol— Naphtol— Naphtol. U. S. i>. 

(Beta-naphtol.) 

Origin. — A phenol occurring in coal-tar, but usually prepared 
artificially from naphtalin. 

Description and Properties. — Colorless or pale buff-colored, 
shining, crystalline laminae, or a white or yellowish-white crystal- 
Hne powder, having a faint, phenol-hke odor, and a sharp, pungent, 
but not persistent taste. Permanent in the air. Soluble in about 
1000 parts of water, in 0.75 part of alcohol, in about 75 parts of 
boiling water, and very soluble in boiling alcohol, ether, chloro- 
form, and solutions of caustic alkalies. It should be kept in dark 
amber-colored, well-stoppered bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Allied Compounds. 

Aliimnol. — An almost colorless, n on -hygroscopic powder; readily soluble in cold 
water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed as a 
local remedy in solutions varying in strength from I to 50 per cent. Used externally. 

Asaprol. — A colorless, neutral crystalline powder, soluble in l\ parts of water and 
in 3 parts of alcohol. — Dose, 15-60 grains (1.0-4.0 Gm.). 

Benzonaphtol. — Obtained by the action of Benzoic Chloride on Beta-naphtol in a 



ANTISEPTICS. 323 

sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the form 
of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). 

Betel (Naphtos^lol — Salinaphtol). — A substance analogous to salol, and pre- 
pared in the same manner, except that sodium-naphtol is used instead of sodium-phenol. 
It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. Insoluble in 
water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 grains (0.12- 
0.3 Gm.). 

Camphorated Naphtol. — Obtained by mixing i part of Beta-naphtol with 2 parts 
of Camphor. It is a brownish, transparent, syrupy liquid. 

Hydronaphtol. — A derivative of beta-naphtol, obtained by the action of reducing 
agents. It occurs in scale-like crystals, of a silvery white or grayish hue, of slightly 
aromatic odor and taste. Soluble in 1 100 parts of water, and freely soluble in alcohol, 
ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12-0.18 Gm.). 



Antagonists and Incompatibles. — Physiological antagonists 
of NAPHTALiN are the same as for other members of this group. 
Naphtol is incompatible with subacetate of lead. 

Synergists. — Carbolic acid and its derivatives. 

Physiological Action. — Naphtalin is antiseptic, antifermenta- 
tive, disinfectant, and deodorant. Its action is quite similar to 
salol, it being insoluble in the gastric juices but to some extent 
soluble in the intestines, where it acts as an antiseptic by local 
contact, deodorizing the stools and often imparting to them its ovvn 
odor. It is absorbed to some extent, and is eliminated by the lungs 
and kidneys, but escapes principally in the feces. It is broken up 
into naphtol or phenol, and acts as a local antiseptic and disinfec- 
tant at points of elimination, but does not occasion any local irri- 
tation unless quite large doses have been taken: "15 grains 
(l.O Gm.) daily have occasioned frequent micturition, with burning 
pain, vesical tenesmus, and redness of the urethral orifice." Purdy 
states that in certain cases of genito-urinary disease he has known a 
dose of 5 grains (0.32 Gm.) to cause severe suffering along the whole 
urinary tract. It is a stimulant expectorant, and differs from other 
members of the group in that it possesses no antipyretic action. 

Naphtol is quickly absorbed when applied locally. It produces 
considerable irritation when used in solution, but has no irritating 
effect when applied in the form of ointment. Toxic effects may 
result from its absorption by the skin, their character resembling 
the action of carbolic acid. 

Aliimnol. — An astringent antiseptic. 

Asaprol. — An antipyretic, analgesic, and antiseptic. It is considered superior to 
the salicylates in these respects, having the advantage of neither exciting vomiting nor 
disturbing the brain or the auditory apparatus. 

Benzonaphtol. — Antiseptic, diuretic, and but slightly poisonous. 



324 A TEXT-BOOK OF MATERIA MEDICA. 

Betol. — Action almost identical with that of salol. 

Hydronaphtol. — A powerful non-irritating, non-corrosive, and non-poisonous anti- 
septic, said by Dr. Fowler to possess " antiseptic properties fifteen times greater than 
carbolic acid." ^ Dr. Levis claims that it is thirty times as antiseptic as salicylic acid, 
and that this property exceeds that of boric acid sixty times, of alcohol six hundred 
times, and that in this respect it ranks next to mercuric chloride. 

Therapeutics. — Externally and Locally. — Naphtalin in alcoholic 
solution is advised by Henri Laserre in the treatment of chronic 
abscesses and adenitis. It is also recommended in the treatment of 
scabies and other parasitic skin diseases. 

Internally. — It is used in typhoid fever and in the gastro-intestinal 
and genito-urinary disorders for which salol and carbolic acid are 
administered, such as chronic diarrhea and dysentery, acute or 
chronic cystitis, etc. 

The internal uses of naphtol are the same as those of naphtalin, 
while externally it may be employed, like carbolic acid or creasote, 
as a general antiseptic in cutaneous disorders, whether organic or 
parasitic. 

Altimnol. — An efficient remedy in many acute and chronic inflammatory diseases^ 
of the skin, and in gonorrhea, chancres, syphilitic ulcers, balanitis, etc. A I per cent, 
solution may be injected in gonorrhea, while stronger solutions (10-50 per cent.), or 
alumnol plaster, are recommended in chronic diseases of the skin. 

Asaprol. — Given for the same purposes as salicylic acid and the salicylates, although 
it is not so uniformly successful in acute articular rheumatism, while having the advan- 
tage of causing less heart-depression. 

Betol. — Used chiefly in the bowel complaints of children. It may be administered 
either by the mouth or through the rectum, associated with bismuth or antacids. It has 
been used also in acute articular rheumatism and bladder affections. 

Camphorated naphtol is considered by some practitioners to be superior to all 
other remedies to prevent suppuration in acute tonsillitis. 

Fernet has employed it successfully in tubercular ulcerations of the tongue, while 
Reboul of Marseilles and others have adopted it with good effect hypodermically in 
tuberculous adenitis and tuberculosis of the testis. It has also been used in tuberculosis^ 
of the bladder, joints, etc. 

Ruault claims it to be an efficient local application to the turbinated bones in 
ozena. 

Hydronaphtol. — Considered by many physicians to be superior to carbolic acid, 
since it is without disagreeable odor and can be used without exciting irritation or 
danger of toxic impression. 

Dockrell employs it in the form of a plaster for destroying the trichophyton fungus 
of tinea tottsurans, and believes it to be superior to mercuric chloride as a germicide. 

It has been used as a preventive of dental caries, and in the treatment of gingivitis, 
pyorrhea alveolar is, diphtheria, etc. 

Internally it has been recommended in dysentery, diarrhea, pulmonary tuberculosis^. 
and typhoid fever. 

1 New York Med. Journ., Oct. 3, 1885. 



ANTISEPTICS. 325 

Contraindications. — These preparations should not be given 
internally when the functional activity of the kidneys is defective. 

Administration. — Naphtalin is best given internally in the 
form of pills or in capsules. When it is necessary to use it topi- 
cally, the offensive odor of the drug may be disguised, it is said, by 
triturating it with a small quantity of the oil of bergamot. Naphtol 
should be given in capsules, in the dose recommended, three times 
a day or oftener if necessary. 

AsAPROL, BETOL, and HYDRONAPHTOL are best given in capsules, 
although betol, which is tasteless and insoluble in water, may be 
administered in the form of powders. 

Resorclnum— Resorcini— Resorcin. 17. H. P. 

Origin. — Prepared by melting Galbanum, Ammoniac, or Guai- 
acum Resin with Potassa. It is also prepared in a similar manner 
from Asafetida, Sagapenum, Ascaroid Resin, and from Phenol- 
sulphonic Acid and other derivatives of Phenol. 

Description and Properties. — Colorless or faintly reddish, needle- 
shaped crystals, or rhombic plates, having a faint, peculiar odor, 
and a disagreeable sweetish and afterward pungent taste. Resorcin 
acquires a reddish or brownish tint by exposure to light and air, 
and should be kept in dark amber-colored vials. It is soluble in 
0.6 part of water, 0.5 part of alcohol, very soluble in boiling water 
and in boiling alcohol, readily soluble in ether and in glycerin, and 
very slightly soluble in chloroform. The aqueous solution is neutral 
or only faintly acid to litmus-paper. 

Dose. — 3-8 grains (0.2-0.5 Gm.). 

Allied and Derivative Compounds. 

Hydroquinol — Hydroquinone — Hydrochirione — Paradioxybenzene. — Color- 
less, odorless, dimorphous crystals, having a sweetish taste. Soluble in 17 parts of water, 
and very soluble in hot water, alcohol, and ether. Dose, l|-5 grains (0.03-0.30 Gm.), 

Catechol — Pyrocatechin — Orthodioxybenzene. — Acicular crystals, readily solu- 
ble in water, alcohol, and ether. 

Other allied compounds are — Thioresorcin, Resopyrine, and Fluorescein. 

Antagonists. — Cerebral excitants, cardiac and respiratory stim- 
ulants. 

Synergists. — Salicylic acid, quinine, carbolic acid. 

Physiological Action. — Externally and Locally. — Resorcin is an 
antiferment, antiseptic, deodorant, a feeble analgesic, and a parasiti- 
cide. Applied to the unbroken skin, it is non-irritating, is not ab- 



326 A TEXT-BOOK OF MATERIA MEDIC A. 

sorbed by it, and when injected into the subcutaneous tissues 
produces but little irritation, with no suppuration. Applied to the 
moistened mucous membrane, its action is similar to that of car- 
bolic acid, producing vesication, etc. 

Internally. — The physiological properties of resorcin are allied 
to those of carbolic acid. It possesses more marked antipyretic 
and diaphoretic actions than carbolic acid, but when used to pro- 
duce these effects it greatly depresses the heart. 

Its chief action is on the nervous system, which it first power- 
fully stimulates and then depresses. 

It is mainly and rapidly eliminated by the urine, which it colors 
an olive-green or bluish-violet hue. 

Poisoning. — Poisonous doses produce vertigo, ringing in the 
ears, deafness, disturbance of vision, weak, rapid, and irregular pulse, 
respiration at first convulsive and jerking, afterward accelerated, 
shallow, and weak, death resulting finally from respiratory failure. 
There are great mental anxiety, epileptiform convulsions, collapse, 
and unconsciousness. Just before death there is a rise in temper- 
ature, doubtless due to excessive muscular action, although the 
temperature may fall below normal if there is quiet narcosis, as 
there may be in some instances. 

Treatment of Poisoning. — Hypodermic injections of atropine. 
The administration of diffusible stimulants. Artificial respiration. 

Therapeutics. — Externally and Locally. — Resorcin is especially 
useful in certain subacute or chronic skin affections, and may be 
used like salicyHc acid in indurated eczema. It is of great value in 
psoriasis, seborrhoea sicca, pityriasis capitis, sycosis, acne rosacea, etc. 

A 5 to I o per cent, solution is an efficient application in pharyn- 
gitis, diphtheria, and idcerative laryngitis. An ointment of resorcin 
is an excellent application to foid idcers, sloughing wounds, and 
syphilitic ulcers. 

Condylomata have been cured by dusting upon them powdered 
resorcin. 

A mixture of powdered resorcin and boric acid (i : 20 or 1:10) 
has been used with brilliant results in suppuration of the middle ear. 

A 2 per cent, solution has been found useful in the form of a 
spray in whooping cough, while stronger solutions of 10 or 20 per 
cent, have been used with some success in hay fever. 

Solutions of resorcin have been used in gonorrhea and cystitis. 

Piternally. — Resorcin is preferable to carbolic acid for internal 
administration, especially in digestive disorders such as gastralgia. 



ANTISEPTICS. 327 

chronic gastritis, ulcer of the stomach, diXid fermentative dyspepsia, so 
called. Owing to its sedative and antifermentative properties, it is 
of value in acute diarrJiea of children. 

It has been used with some success in intermitte7it fever, but 
not with good results sufficiently uniform to justify the exclusion 
of quinine. As an antipyretic it may be used when a drug of that 
character is indicated, but it is not equal to antipyrine or acetanilid, 
and in doses sufficient to produce the desired reduction of temper- 
ature it is too depressant to the heart. Its chief therapeutic value 
is for external or local use, and internally for the digestive disorders 
above mentioned. 

Administration. — It should be given in pills or capsules. 

Ichthyolum— Ichthyoli— Ichthyol. (Unofficial.) 

Origin. — It is obtained by the destructive distillation of bitumin- 
ous rock found near Seefeld in the Tyrolese Alps, which contains 
enormous quantities of semi-fossilized fishes and marine animals. 

Description and Properties. — It occurs in the form of a brown- 
ish-yellow, transparent, oily liquid, containing about 10 per cent, of 
sulphur. 

Upon being treated with concentrated sulphuric acid ichthyol 
is converted into ichthyol-sulphonic acid, which readily combines 
with ammonia and other alkalies, as well as with lithium, zinc, 
mercury, etc., forming the ammonium ichthyol, sodium ichthyol, 
zinc ichthyol, etc. 

Ammonium ichthyol occurs as a clear reddish-brown, syrupy 
liquid with a bituminous odor and taste. Soluble in water and in 
a mixture of equal volumes of ether and alcohol. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

The other salts of ichthyol-sulphonic acid occur as brownish or 
black tar-like masses, the sodium salt being the most important, 
as it is the one most employed when ichthyol is desirable in pill 
form. 

Dose. — Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). 

Allied Drugs. 

Thiolum — Thioli — Thiol. — Origin. — This substance is prepared by heating 
brown-colored paraffin or gas oils with Sulphur, and extracting the sulphurated, unsatu- 
rated hydrocarbons with Alcohol, 

Description and Properties. — It occurs as a neutral, solid body, non-hygroscopic 
and soluble in water, and of a dark -brown color, or in the form of a dark reddish- 
brown, syrupy liquid, containing about 40 per cent, of thiol. 



328 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — 2^-1 grain (0.03-0.06 Gm.). 

Tumendlum — Tumenoli — Tumenol. — Origin. — It is obtained from purified 
mineral oils by the direct action of concentrated sulphuric acid, without previous sul- 
phuration, being a mixture of sulphones and sulphonic acids. 

Description and Properties. — A dark-brown or blackish-brown liquid of a syrupy 
consistency. 

Dose. — It is used only externally, in strengths of from 5 to 10 per cent. 

Antagonists and IncompatibleSo — Ichthyol possesses marked 
reducing properties, and should not therefore be combined with 
substances, like potassium permanganate, which part readily with 
oxygen. 

Synergists. — Most members of this group, particularly the tars, 
carbolic acid, creasote, etc., aid its action. 

Physiological Action. — Externally and Locally. — Ichthyol is 
ischemic, sedative, parasiticide, and possesses antiseptic and prob- 
ably disinfectant properties. 

When applied to the skin in full strength it produces some irri- 
tation. It is readily absorbed, having the power to penetrate the 
skin, affecting the deeper tissues beneath. 

Internally. — Digestive System. — Very large doses produce con- 
siderable gastro-intestinal irritation. 

Circulatory System. — It has the power in medicinal doses of 
contracting the caliber of the arteries, and in large doses it increases 
the migration of the white blood-corpuscles. 

The physiologicar action has not been fully studied, and it is 
not yet positively known what action it has upon the nervous and 
respiratory systems and upon temperature. 

Therapeutics. — Externally and Locally. — Ichthyol was intro- 
duced by Unna as a valuable remedy in certain diseases of the 
skin. It is particularly useful in erytheinatous eczema, erysipelas, 
lupus erythematosus, irritable acne, and certain forms of acne rosacea. 

Agnew has employed it with advantage in lymphatic enlarge- 
ments. It has also been found useful in synovial inflammations, in- 
flammatory conditions of the female genital organs, and in certain 
diseases of the ear and nose. 

Thiol, although inferior, is similar to ichthyol in its therapeutic 
action. It has been found to be valuable in the treatment of herpes 
zoster, dermatitis herpetiformis, and erythema midtiforme. 

Administration. — Ichthyol, when given internally, should be 
dispensed in capsules, while thiol may be given in capsules, pills, 
or wine. 

Externally, ichthyol may be employed in solution, dissolved in 



ANTISEPTICS. 329 

chloroform or in a mixture of alcohol and ether, and applied with 
a brush ; or in the form of an ointment mixed with soft petrolatum 
or lanolin in from 1-4 to 8 drachms (4.0-1 5.0 Cc. to 32.0 Gm.). It 
is used also in the form of a soap in from 5 to 20 per cent, strength. 
Thiol is used locally in powder form, or as an ointment of 5 to 
10 per cent, of the liquid, or in collodion containing 5 per cent, of 
the powder, or in solutions of glycerin and aqueous solutions con- 
taining from 5 to 50 per cent, of the powder. 

lodoformum—Iodoformi— Iodoform. 77. H* B. 

Orig"in. — It is obtained by the action of Iodine, in the presence 
of fixed alkalies or alkali carbonates, upon Alcohol or Acetic and 
other easily-saponifiable Ethers. 

Description and Properties. — Small, lemon-yellow, lustrous 
crystals, of the hexagonal system, having a peculiar, very pene- 
trating, and persistent odor, somewhat resembhng that of saffron 
and iodine, and an unpleasant, slightly sweetish, and iodine-like 
taste. It is very slightly soluble in water, to which, however, it 
imparts its odor and taste; soluble in about 52 parts of alcohol, in 
about 12 parts of boiling alcohol, or in 5.2 parts of ether, and very 
soluble in chloroform, benzin, and fixed and volatile oils. 

Iodoform is slightly volatile, even at ordinary temperatures, and 
in boiling water distils slowly over with its vapor. It should be 
kept in well-stoppered bottles, in a cool and dark place. 

Iodoform contains 96.69 per cent, of its weight as iodine. 

Dose. — -1-3 grains (0.06-0.2 Gm.). 

Official Preparation, 

UnguSntum Iodof6rmi — UnguSnti lodofSrmi — Ointment of Iodoform. — 10 

per cent. Used externally, 

Allied Compounds. 

AntisSptol — Cinchonine lodosulphate. — Origin. — It is prepared by mixing an 
aqueous solution of Cinchonine Sulphate with an aqueous solution of Iodine and Potas- 
sium Iodide, and washing and drying the resulting precipitate. 

Description and Properties. — It occurs as a light reddish-brown powder, insoluble in 
water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Aristol — Dithymol Di-iodide. — Origin. — It is obtained by adding a solution of 
iodated Iodide of Potassium to an aqueous solution of Hydrate of Sodium containing 
thymol. The resulting precipitate is washed and subsequently dried at ordinary tem- 
perature. 

Description and Properties. — A dark, brownish-red, amorphous, almost tasteless 
powder, of a slight, peculiar, iodine-like odor, insoluble in water and glycerin, sparingly 



330 A TEXT-BOOK OF MATERIA MEDICA. 

soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also 
taken up by fixed oils, petrolatum, etc. 

Aristol is decomposed by heat and light, and it should be kept in dark amber-^ 
colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. 

Dose. — It is not given internally. 

Europhen. — Prepared in a manner analogous to that of preparing aristol, except 
that isobutylorthocresol is used in place of thymol. 

Description and Properties. — An amorphous, yellow powder, having an odor resem- 
bling saffron ; soluble in ether, chloroform, and fixed oils ; insoluble in water and 
glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, 
forming a new soluble iodine compound. When heated to 110° C. (230° F.) it melts, 
forming a clear brown liquid. It contains 27.6 per cent, of iodine. 

Dose. — \-'i.\ grains (0.016-0.09 Gm.). It is used hypodermically in olive oil, and 
externally in the form of an ointment, in strengths varying from 3 to 10 per cent. 

Antagonists and Incompatibles. — It is incompatible with the preparations of mercury 
and zinc, with metallic oxides, and with starch. 

lodol. — Origin. — Obtained by the interaction of Iodine and Pyrrol (a constituent of 
mineral oil) in Alcoholic Solution for twenty-four hours, the iodol being precipitated upon 
the addition of Water; or it may be prepared after the manner of preparing aristol^ 
except that Pyrrol is used instead of Thymol. 

Description and Properties. — It is a pale-yellow or grayish-brown, more or less, 
crystalline, bulky, tasteless, and odorless powder. It is insoluble in water, and but 
slightly soluble in diluted alcohol. It is soluble in alcohol and ether. The alcoholic 
solution is miscible with glycerin, but when mixed with water a milky precipitate is 
formed. Iodol contains 88.97 P^'* cent, of iodine. 

Dose. — \\-2 grains (0.03-0. 1 2 Gm.). 

L6sophene. — Origin. — Prepared by slowly adding an aqueous solution of Iodine and 
Iodide of Potassium to an aqueous solution of Ortho-oxyparatoluic Acid and Sodium Bicar- 
bonate. The precipitate formed is washed with Water and recrystallized from Alcohol. 

Description and Properties. — It occurs as colorless, odorless, needle-shaped crystals. 
Insoluble in water and alcohol, but readily soluble in ether, benzene, chloroform, and 
fixed oils. It contains 78.39 per cent, of iodine. 

Dose. — It is used externally. 

SozoiOdol. — Origin. — A combination of Iodine 54 per cent., Carbolic Acid 20 per 
cent., and Sulphur 7 per cent. 

Description and Properties. — The sodium, potassium, ammonium, mercury, lead, and 
zinc salts of this acid are the preparations used, the sodium salt being the one most 
commonly employed. The sodium sozoiodolate occurs in bright, prismatic, needle-shaped 
crystals. Soluble in water, alcohol, and glycerin. 

Dose. — For external use, in strengths varying from 3 to 20 per cent. 

Sulphaminol. — Origin. — It is formed by the action of Sulphur on the salts of Meta- 
oxydiphenylamine. 

Description and Properties. — It is a yellow powder, insoluble in water, readily solu- 
ble in alkalies, alcohol, and glacial acetic acid. 

Dose. — 1-4 grains (0.006-0.25 Gm.). 

Antagonists and Incompatibles. — lodotbrm i.s incompatible 
with mercuric chloride. 

Physiolog-ical Action. — Externally and Locally. — Iodoform or- 
dinarily possesses no irritating action when applied to the skin or 



ANTISEPTICS. 331 

mucous membranes, or to ulcers and wounds. On the contrary, 
it possesses analgesic properties. It has a tendency to check serous 
oozing when applied to wounds. 

Internally. — Digestive System. — Small doses, if they have any 
effect, slightly increase the appetite, and tend to increase the sali- 
vary, biliary, and intestinal secretions. Large doses disturb the 
stomach, and may occasion nausea, vomiting, and diarrhea. 

Circulatory System. — Small doses retard and strengthen the 
pulse, and, for a brief period only, increase arterial tension. Full 
medicinal doses lessen arterial tension and render the pulse slower 
and weaker. Lethal doses rapidly accelerate the pulse, causing it 
to become irregular ; later, the action of the heart is slowed, and 
finally arrested in diastole, from paralysis of the cardiac muscle. 

Nervous System. — Large doses are apt to produce headache, 
restlessness, delirium, or stupor. The reflexes may be depressed, 
or in some cases choreic movements may appear. Muscular con- 
tractility and the excitability of the nerve-centers to external stimu- 
lation are lessened. 

Respiratory System. — Very large doses produce convulsive res- 
piratory movements. 

Absorption and Elimination. — Iodoform is absorbed from the 
stomach, or from mucous membranes or wounds to which it is 
applied. It is slowly absorbed from the alimentary canal, but readily 
absorbed from wounds. In the tissues it combines with the proteid 
molecules, and is retained in the system as potassium iodide and 
other iodides. It is eliminated in all the secretions, and has been 
detected in the urine and saliva within one hour after its administra- 
tion, traces of it being perceptible in the secretions for three days. 
Iodine is liberated at the points of elimination, either as an iodate or as 
some organic compound of iodine, or both. The drug is also detected 
in the breath, though it is chiefly eliminated in the urine as alkaline 
sodium iodate, coloring the urine yellow. It should be remembered 
that iodoform is absorbed much more rapidly than it is eliminated. 

Temperature. — Large doses cause a rise of temperature, while 
poisonous doses may, at the last, produce a decided reduction of 
animal heat. 

Untoward Action. — Sometimes iodoform excites an eczematous 
eruption, which may be papular or erythematous, and symptoms of 
vertigo. Muscular weakness and double vision have also been 
observed; sleepiness, alternating with excitement; incoherence of 
speech ; headache ; mental confusion ; and amblyopia. 



332 A TEXT-BOOK OF MATERIA MEDICA. 

Poisonmg. — Three forms of poisoning by iodoform are described 
by Duret — the eruptive, the cerebral, and the syncopal. 

In the first of these there may be a severe and extensive ery- 
thema or eczematous eruption. The cerebral variety is character- 
ized by rapid increase of temperature and accelerated pulse — as 
high as 150 or 175 per minute; great irritation of the gastro-intes- 
tinal tract ; widely dilated, or motionless and contracted, pupils ; 
intense headache over the entire circumference of the head ; mel- 
ancholia ; great depression of spirits ; hallucinations and active 
delirium or suicidal mania. 

In the syncopal variety the patient complains of dizziness and 
mental confusion ; is languid and weak ; the heart's action becomes 
very rapid and feeble, the patient passing at length into a lethargic 
or comatose condition, with paralysis of the sphincters, and finally 
dying, perhaps quite suddenly. 

The symptoms of poisoning may appear soon after the appHca- 
tion of the drug, or they may be deferred for days and even weeks. 
In the latter case, which may properly be termed chronic poison- 
ing, the patient is more apt to be melancholy, weak, and apathetic, 
with slight fever and accelerated pulse. Old people are the more 
susceptible to its toxic influence. 

Treatment of Poisoning. — Every particle of the drug should be 
immediately removed from the body or its internal administration 
be discontinued at once. Stimulants, diaphoretics, and diuretics 
should be given, with frequent bathing of the body in warm water, 
to hasten elimination. Opium and large doses of potassium bicar- 
bonate have been recommended. 

Therapeutics. — Externally and Locally. — Iodoform acts as an 
alterative, analgesic, protectant, antiseptic, and germicide to at least 
some forms of bacilli. It is therefore one of the best applications 
to wonnds, 7dcers, etc. It is especially valuable in the treatment of 
tubercular affections, such as tuber cidar joi7its, when it is used in 
the form of an injection — 10 to 20 per cent. — in sterilized olive oil. 
In tubercidar parenchymatous synovitis the mixture is injected di- 
rectly into the joint-cavity. Rinonapoli recommends a 10 per 
cent, ethereal solution in malignant pustide, injected hypodermically 
into the base of the tumor ; while Terrier and Mosetig von Moorhof 
have both used it successfully in parenchymatous goiter. 

Iodoform is an exceedingly valuable application to syphilitic 
ulcers, chancres, chancroids, suppurating buboes, ulcerations of the 
uterus, uterine cancer, and indolent and irritable ulcerations of the leg. 



ANTISEPTICS. ZZZ 

Incorporated in a suppository, it is very efficacious in painful 
hemorrhoids, fistula^ and fissure of the amis. 

It is a valuable application in many diseases of the ear, nose^ 
throat, eye, and skin where a drug of this character is indicated. 

Internally. — Iodoform is used but very little internally, although 
it has been employed in pJitJiisis, Jienioptysis, syphilis, catarrhal 
jaundice, hepatic cirrhosis, gastric catarrh, diabetes, and as an intes- 
tinal antiseptic. 

The allied compounds mentioned above are used locally as sub- 
stitutes for iodoform. Most of them possess the great advantage 
of being odorless, and some of them seem to be in all respects 
quite as efficient as iodoform. Aristol is undoubtedly superior to 
it in the treatment of iitdolent zi leers and in many diseases of the 
skin, ear, nose, and throat. Europhen and iodol should certainly 
replace iodoform in many cases. 

Administration. — Internally, iodoform should be given in pills 
or capsules. Externally, it may be used in the form of a powder, 
alone or mixed with powdered borax or boric acid. It is also used 
in the form of an ointment or collodion. It is given hypodermi- 
cally, mixed with olive oil and glycerin, or dissolved in ether, in 
strengths varying from lo to 30 per cent. 

Its disagreeable odor may be modified or disguised by mixing 
it with tar, liquid styrax, balsam of Peru, thymol, coumarin, 
menthol, ground coffee, oil of lavender, bergamot, bitter almond, 
coriander, musk, vanilla, or some similar aromatic and pleasantly 
odorous substance. 

BenzoTnum—BenzoTni— Benzoin. TJ. S. J*. 

Origin. — A balsamic resin obtained from Styrax Benzoin Dry- 
ander, a large tree indigenous in Sumatra and Java, and probably 
also in Cochin China and Siam. 

Description and Properties. — Benzoin exudes from incisions in 
the bark, and upon exposure to the air hardens into lumps con- 
sisting of agglutinated, yellowish-brown tears, which are internally 
milk-white, or in the form of a reddish-brown mass, more or less 
mottled from whitish tears imbedded in it. It is almost wholly 
soluble in 5 parts of moderately warm alcohol and in solutions of 
the fixed alkalies. When heated it gives off fumes of benzoic acid. 
It has an agreeable balsamic odor and a slight aromatic taste. 

Benzoin is of the nature of a balsam, containing from 20 to 24 
per cent, of benzoic acid, resin, and volatile oil. Some varieties 



334 ^ TEXT-BOOK OF MA TERIA MEDICA. 

contain cinnamic acid, which is undesirable, while the benzoin from 
Siam contains vanillin and possesses the odor of vanilla. 
Dose. — Benzoin is never administered in substance. 

Official Preparations. 

Adeps Benzoinatus — Adipis Benzoinati — Benzoinated Lard (2 per cent.). — 
For external use. 

Tinctura Benzoini — Tincturae Benzoini — Tincture of Benzoin, — Dose^ 30 
minims to I fluidrachm (2.0-4.0 Cc). 

Tinctura Benzoini Composita — Tincturae Benzoini CompSsitse — Com- 
pound Tincture of Benzoin. — Benzoin, 2; Aloes, 2; Storax, 8; Tolu, 4; Alcohol, 
74 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Antagonists and Incompatibles. — The tincture and compound 
tincture are incompatible with aqueous preparations, the benzoins 
and other resins and balsams being precipitated from their alcohoHc 
solutions by water. 

Physiological Action. — The action of benzoin is due to the 
benzoic acid which it contains, and will therefore be considered 
under Benzoic Acid. 

Acidum Benzoicum— Acidi Benzoici— Benzoic Acid. 

V. S. JP. 

Orig-in. — An organic acid usually obtained from Benzoin by 
sublimation, or prepared artificially, chiefly from Toluol. 

Description and Properties. — White or yellowish-white lus- 
trous scales or friable scales, having a slight characteristic odor 
resembling that of benzoin, and of a warm, acid taste ; somewhat 
volatile at a moderately warm temperature, and rendered darker 
by exposure to hght. Soluble when pure in about 500 parts of 
water, in 2 parts of alcohol at about 15° C. (59° F.), in 15 parts 
of boihng water, and in i part of boiling alcohol. It is also soluble 
in 3 parts of ether, 7 parts of chloroform, and readily soluble in 
carbon disulphide, in benzol, and in fixed and volatile oils. Sparingly 
soluble in benzin. 

Benzoic acid has an acid reaction and is inflammable. It should 
be kept in dark amber-colored, well-stoppered bottles and in a cool 
place. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Amm5nii Benzoas— Ammonii Benzoatis— Ammo- 
nium Benzoate. U.S.JP. 

Origin. — Dissolve Benzoic Acid in Water of Ammonia and Dis- 
tilled Water, evaporate, and crystaUize. 



ANTISEPTICS. 335 

Description and Properties. — Thin, white, four-sided laminar 
crystals ; odorless, or having a slight odor of benzoic acid ; a sa- 
line, bitter, afterward slightly acrid taste, and gradually losing am- 
monia on exposure to air. Soluble, at 15° C. (59° F.), in 5 parts 
of water, in 28 parts of alcohol, in 1.2 parts of boiling water, and 
in jh parts of boiling alcohol. The salt is neutral or has a very 
slight reaction upon litmus-paper. It should be kept in well- 
stoppered bottles. 

Dose. — 10-20 grains (0.6-1.2 Gm.). 

Lithii Benzoas— Lithii Benzoatis— Lithium 
Benzoate. IJ» S. JP. 

Origin. — Prepared by decomposing Lithium Carbonate with 
Benzoic Acid. 

Description and Properties. — A light white powder, or small, 
shining, crystalline scales ; odorless or of a faint, benzoin-like odor, 
and of a cooling, sweetish taste ; permanent in the air. Soluble in 
4 parts of water, in 12 parts of alcohol, in 2.5 parts of boiling water, 
and in 10 parts of boiling alcohol. The presence of sodium ben- 
zoate increases the solubility in water and lessens it in alcohol. 
The aqueous solution (i in 20) of lithium benzoate has a faintly 
acid reaction upon litmus. 

Dose. — 5-20 grains (0.3-1,2 Gm.). 

Sodii Benzoas— Sodii Benzoatis— Sodium 
Benzoate. TI, S, I". 

Orig-in. — Prepared by decomposing Sodium Carbonate with 
Benzoic Acid. 

Description and Properties. — A white amorphous powder, 
odorless or having a faint odor of benzoin and a sweetish, astrin- 
gent taste. Soluble in 1.8 parts of water, in 45 parts of alcohol, 
in 1.3 parts of boiling water, and in 20 parts of boiling alcohol. 
The aqueous solution is neutral to litmus-paper. It is efflorescent, 
and should be kept in well-stoppered bottles. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Allied and Unofficial Preparations. 

Bismuthi BSnzoas — Bismuthi Benzoatis — Benzoate of Bismuth. 
MSnthol BSnzoas — MSnthol Benzoatis — Benzoate of Menthol. — For exter- 
nal use. 



Antagonists and Incompatibles. — Benzoic acid is incompatible 



2,2>^ A TEXT-BOOK OF MATERIA MEDICA. 

with the alkahne salts, as those of sodium, etc., and ammonium 
BENZOATE is incompatible with the ferric salts. 

Physiolog'ical Action. — Externally. — When applied in a con- 
centrated form to the skin or mucous membrane benzoic acid is an 
irritant, and produces a catarrhal condition of the bronchial mucous 
membrane when its vapors are inhaled. It is a powerful antiseptic 
and germicide, preventing the growth of putrefactive bacteria in 
a solution of i : looo. 

Ijiternally. — Digestive System. — In full medicinal doses benzoic 
ACID irritates the throat and produces a sense of heat in the epi- 
gastrium. Very large doses may occasion gastric inflammation, 
with nausea and vomiting. The functional activity of the liver is 
stimulated by sodium benzoate. 

Circulatory System. — In large doses benzoic acid increases the 
pulse-rate to a marked extent, and is a stimulant to the entire 
circulatory apparatus. 

Respiratory System. — It is a powerful stimulant in moderate 
medicinal doses, increasing the respiratory movements and promot- 
ing the bronchial secretion. 

Absorption and Elimination. — It is eliminated chiefly by the 
kidneys, but also by the skin, salivary glands, and broncho-pul- 
monary mucous membrane. 

The important action of benzoic acid is the change it undergoes 
in the kidneys, being converted into hippuric acid, in combination 
with glycocoU. This change takes place only in the kidneys, and 
the hippuric acid formed renders alkaline urine acid, besides in- 
creasing the urinary flow and disinfecting and stimulating the 
genito-urinary tract. 

Temperature. — Like other members of this group, the acid, as 
well as its salts, possesses antipyretic properties, many observers 
holding it to be equal, if not superior, to salicylic acid in this 
respect. It is not yet known in what manner it reduces temper- 
ature. 

Untoward Action. — Benzoic acid sometimes produces urticaria 
or an erythematous condition of the skin. 

Therapeutics. — Externally and Locally. — The compound tinc- 
ture OF benzoin is an admirable preparation for many conditions 
requiring antiseptic, astringent, and stimulating dressing. It is fre- 
quently applied to cuta7ieous wounds, the alcohol evaporating and 
leaving upon the injured parts a protective film of balsams. A 
piece of lint or absorbent cotton saturated with the compound 



ANTISEPTICS. 337 

tincture has been used to close the punctures in the skin after 
tenotomy. 

Stille recommends a combination of the compound tincture of 
benzoin and glycerin for the treatment of chapped hands and lips^ 
frost-bite, and fissured and chapped nipples. 

R. W. Taylor treats " ringworm of the thighs " by painting the 
affected part with a mixture of bichloride of mercury and com- 
pound tincture of benzoin, 2-5 grains to i ounce (0.12-03 to 30.0 
Cc). 

The compound tincture, diluted with water in various propor- 
tions, makes an efficient application in catarrhal affectio7is of the 
pharynx and larynx, either in the beginning of an inflammation or 
during the relaxed condition which so often accompanies the ter- 
mination of an acute attack. The hoarseness of vocalists and pubHc 
speakers, the result of excessive strain upon the vocal cords, is 
frequently relieved by this remedy. 

Inhalations of benzoin are a popular and frequently effective 
method of treating acute catarrhal inflainmation of the upper 
respiratory passages. 

The cough and expectoration of chronic bronchitis and chronic 
phthisis are eased and lessened by inhahng night and morning a 
drachm (4 Gm.) of benzoic acid, added to boiling water. 

A preparation Hke the following is an efficient and agreeable 
lotion for irritative forms of chronic nasal catarrh : 

R. Sodii boratis, aa. ^ij (60.0 Gm.) ; 

Acidi benzoici, gr. x (0.6 Gm,). — M. 

Fiat pulvis No. i. 

Sig. To half a tumblerful of water add hall a teaspoonful each of the powder and 
glycerin. Use freely as a lotion. 

The simple tincture of benzoin is an excellent apphcation to 
spongy gums. There is much evidence of the efficiency of bismuth 
BENZOATE as a dressing for chronic or sloughing tdcers. Specific 
sores, cha7uroids and chancres especially, are well treated by dust- 
ing the parts with the benzoate after thoroughly bathing the surface 
with a weak solution of bichloride of mercury. 

Probably the most important therapeutic action of benzoic acid 
is shown in the treatment of cystitis and pyelitis accompanied by 
decomposing and alkaline urine. 

The uric-acid diathesis is modified by this drug and its prepara- 
tions, particularly by the lithium benzoate. Phosphatic calculi 
22 



338 A TEXT-BOOK OF MATERIA MEDICA. 

may be dissolved by the prolonged administration of ammonium 
BENZOATE, which is preferable to benzoic acid for this purpose. In- 
continence of urine, if due simply to the alkalinity of the urine, is 
relieved by the same remedy. 

Liegeois has employed sodium benzoate as a cholagogue with 
excellent results. He associates it with rhubarb. He also states 
that benzoate of sodium favorably modifies the pain of pharyngitis. 
Sodium benzoate is an excellent substitute for sodium salicylate, 
being especially useful in the septic diseases. It is equally power- 
ful as an antiseptic and antipyretic, though slower in its action than 
sodium salicylate. Its effects, however, are more permanent, and 
innocuous. 

Administration. — Benzoic acid is best administered in pill form 
or in capsules, with balsam of fir or Castile soap as an excipient. 
The soluble benzoates may be given in solution in some aromatic 
water or in compressed pills. The solution, however, is preferable, 
and the unpleasant taste may be well disguised by a little spirit of 
chloroform. When any of these preparations are given for their 
action upon the urinary tract, it may sometimes be advantageous 
to combine them with a urinary sedative, such as tincture of bella- 
donna or hyoscyamus. 

Myrrha— My rrhae— Myrrh. TJ. S. I". 

Origin. — A gum-resin obtained from Commiphora Myrrha 
(Nees) Engler, a shrub or small tree '' forming the chief underwood 
of the Arabian and African forests along the shores of the Red 
Sea." 

Description and Properties. — Roundish, irregular tears or 
masses, dusty brownish-yellow or reddish-brown ; fracture waxy, 
somewhat splintery, translucent on the edges, sometimes marked 
with whitish veins ; odor balsamic ; taste aromatic, bitter, and acrid. 
It contains 60 per cent, of gum, 35 per cent, of resin, and 3 or 4 
per cent, of a volatile oil (myrrhol). 

Dose. — 5-30 grains (0.3-2.0 Gm.), in pills or emulsion. 

Official Preparations. 

Mistura FSrri Comp6sita — Misturse FSrri CcmpSsitae — Compound Iron 
Mixture. — Dose, \-2. fluidounces (15-60 Cc). 

Pilulae Aloes et Myrrhae — Pilulas (ace.) Aloes et Myrrhae— Pills of Aloes 
and Myrrh. — Dose, 2 to 5 pills. 

Tinctiira Aloes et Myrrhae — Tinctiirae Aloes et Myrrhae— Tincture of Aloes 
and Myrrh (10 per cent.). — Dose, \-2 fluidrachms (2-8 Cc). 



ANTISEPTICS. 339 

Tinctura Myrrhae — Tincturae Myrrhae — Tincture of Myrrh (20 per cent.). — 
Dose, 15-60 minims (1-4 Cc). 

Physiolog'ical Action. — Myrrh is astringent, disinfectant, slightly 
antiseptic, and stimulant. Its action resembles that of the aro- 
matics, stimulating the appetite and acting as a carminative, exces- 
sive doses causing nausea and vomiting. It increases the number 
of white blood-corpuscles, and is a stimulant to the circulation. 

The drug is eliminated by the mucous membranes generally, aug- 
menting and disinfecting their secretions. It possesses emmena- 
gogue properties. 

Therapeutics. — As a stimulant and astringent myrrh is service- 
able as a mouth-wash in ptyalisin and spongy gums and in ozena. 
It is useful as a gargle in pharyngitis, relaxed throat, etc., and as an 
injection in lettcorrhea, the latter disease, as well as cystitis, being 
favorably influenced by the internal administration of the drug. It 
has been used internally, with considerable success, as a stimulant 
expectorant in broncJiorrJiea and cJironic bronchitis, and as a stom- 
achic in atonic dyspepsia. 

Administration. — Myrrh may be given internally in the form 
of an emulsion or pills. The tincture, either in full strength or 
diluted, is chiefly employed externally. 

Balsamum Peruvianum— Balsami Peruvian!— Bal- 
sam of Peru. 77. >S^. J*. 

Origin. — A balsam obtained from Tolnifera Pareh^cE (Royle) 
Baillon, a tree growing in Brazil and near the west coast of South 
America. 

Description and Properties. — A liquid having a syrupy con- 
sistence, free from stringency or stickiness, of a brownish-black 
color in bulk, reddish-brown and transparent in thin layers, of an 
agreeable, vanilla-like, somewhat smoky odor, and a bitter taste, 
leaving a persistent after-taste. On exposure to air it does not 
become hard. It is completely soluble in 5 parts of alcohol. 

The drug contains, among other substances, benzoic and cin- 
namic acids, cinnamein about 60 per cent., and resin 32 per cent. 

Dose. — 8-30 minims (0.5-1.84 Cc). 

Physiolog'ical Action. — Its properties are similar to those of 
myrrh, its action being almost analogous. 

Therapeutics. — In various cutaneous disorders balsam of Peru 
is very efficient, being employed in pruritus vidvce, eczema, scabies^ 
ringworm, etc. It is remarkably efficacious as an application to 



340 A TEXT-BOOK OF MA TERIA MEDICA. 

cracked nipples^ cracked lips, indolent sores, bed-sores, etc., and is 
also serviceable in certain diseased conditions of the nose and 
throat, such as atrophic rhinitis and tonsillar diphtheria. 

As a stimulant expectorant the drug is efficient in chronic bron- 
chitis, being regarded by some physicians as of great service in 
phthisis pulmonalis. Like myrrh, balsam of Peru has been used 
to some extent as a stomachic carminative and tonic. 

Administration. — It is best given in an emulsion or in glycerin. 

Eucalyptus— Eucalypti— Eucalyptus. U* S. J*. 

Origin. — The leaves of Eucalyptus globulus Labillardiere, col- 
lected from the older part of the tree. The blue-gum tree is a rapid 
grower, attaining a height of 200 to 300 feet (60-90 M.). It is 
native to Australia, but is cultivated in various portions of Europe, 
Africa, and the United States with the view of rendering malarial 
districts habitable by its antiseptic exhalations. 

Description and Properties. — Petiolate, lanceolate, scythe- 
shaped, from 6 to 12 inches (15-30 Cm.) long, rounded below, 
tapering above, entire, leathery, grayish-green, glandular, feather- 
veined between the midrib and marginal veins ; odor strongly cam- 
phoraceous ; taste pungently aromatic and somewhat cooling, bitter, 
and astringent. 

The most important constituent is a volatile oil, of which the 
leaves yield about 6 per cent. 

Dose. — \-2 drachms (2.0-8.0 Gm.). 

Official Preparation. 

Extractum Eucalypti Fluidum— Extract! Eucalypti Fluidi— Fluid Extract 
of Eucalyptus. — Dose, 5-60 minims (0.3-4.0 Cc). 

Oleum Eucalypti— Olei Eucalypti— Oil of Eucalyp- 
tus. U.S. I". 

Orig-in. — A volatile oil distilled from the fresh leaves of Euca- 
lyptus globulus Labillardiere, E. oleosa F. v. Miiller, and some 
other species of the genus. 

Description and Properties. — A colorless or faintly yellowish 
hquid, having a characteristic, aromatic, somewhat camphoraceous 
odor, and a pungent, spicy, and cooHng taste. Soluble in all 
proportions in alcohol. This oil consists of two hydrocarbons 
(cymene and eucalyptene), terpene, and a substance upon which its 
medicinal value depends — eucalyptol. Oil of eucalyptus should be 



ANTISEPTICS. . 341 

kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 5-15 minims (0.3-1. Cc). 

Eucalyptol— Eucalyptol— Eucalyptol. TJ. S. J*. 

Orig-in. — A neutral body obtained from the volatile oil of 
Eucalyptus globulus. 

Description and Properties. — A colorless liquid, having a cha- 
racteristic, aromatic, and distinctly camphoraceous odor, and a pun- 
gent, spicy, and cooling taste. Soluble in all proportions in alcohol. 

Dose. — 5-10 minims (0.3-0.6 Cc). 

Unofficial Preparations. 

Aqua Eucalypti — Aquae Eucalypti — Eucalyptus Water. — Dose, 2-4 fluid- 
drachms (7.39-15.0 Cc). 

Tinctura Eucalj^pti— Tincturae Eucalypti— Tincture of Eucalyptus.— Z>^j^, 
1-4 fluidrachms (3.7-1 5.0 Co.). 

Antagonists and Incompatibles. — Agents promoting waste an- 
tagonize the therapeutic action of eucalyptus. The chemical incom- 
patibles are the mineral acids, mineral salts, and alkahes. 

Synergists. — The vegetable bitters, aromatics, antispasmodics, 
turpentine, cubebs, and copaiba. 

Physiolog-ical Action. — Externally and Locally. — Locally ap- 
plied, the oil of eucalyptus and eucalyptol are more or less irritant, 
though perhaps less active than many volatile oils. In contact with 
mucous membranes or injected hypodermically, they cause pain, 
and, when swallowed, produce a burning sensation in the throat, 
stomach, and intestines. 

If the vapor of eucalyptus be confined by preventing evapora- 
tion, vesication and pustulation result, the drug also acting as a 
rubefacient. Inhalation affects the bronchial mucous membrane 
unfavorably, the beneficial effects of the remedy residing in its 
properties as a powerful antiseptic and disinfectant. It is also 
sHghtly detergent and astringent. 

hiternally. — Digestive System. — Small doses, by stimulating the 
salivary and peptic glands, improve the appetite and digestion, 
while peristalsis is increased, the drug acting as a mild laxative. 
The ingestion of large amounts may occasion anorexia, nausea, 
vomiting, and perhaps diarrhea, although the drug cannot be con- 
sidered an active emetic nor does it possess marked purgative 
properties. 



342 A TEXT-BOOK OF MATERIA MEDICA. 

Circulatory System. — Like quinine, eucalyptus arrests the ame- 
boid movements of the white blood-corpuscles. It resembles that 
drug also in its reputed property of contracting the enlarged spleen. 
Medicinal doses of eucalyptol stimulate the heart, increasing the 
blood-pressure — probably the effect of reflex action from the stom- 
ach. The arterial tension, however, though at first raised, is sub- 
sequently reduced, the pulse, which under moderate amounts of 
the drug shows an increase in force and frequency, being lowered 
hy immoderate dosage. 

Nervous System. — Small doses stimulate mental activity. Fre- 
quent accompaniments of large doses are insomnia in the healthy 
and somnolence in debilitated subjects, and under certain condi- 
tions cerebral congestion, owing to the increased quantity of blood 
sent to the brain. Large or toxic doses are powerfully depressant 
to the brain, medulla, and spinal cord, abolishing the reflexes and 
at times occasioning loss of sensation in the lower Hmbs. " In 
large doses, after absorption, it seems to act chiefly on the ner\^e- 
centers, producing paralysis and death" (Hare). 

Respiratory System. — The drug tends to accelerate the respira- 
tory movements under small or moderate dosage ; poisonous doses 
retard the breathing, finally arresting it, and causing death by 
paralysis of respiration. 

Absorption and Elimination. — The drug acting as a marked diu- 
retic, it is natural that elimination should take place largely by the 
kidneys. The skin, bowels, and bronchial mucous membrane share 
in the excretory process, the drug acting as a stimulant to the 
structures by which elimination takes place. A characteristic odor 
— resembhng that of violets — is imparted to the urine, breath, and 
discharges from the bowels. Renal congestion, with pain in the 
region of the kidneys, is occasionally produced by very large doses 
of the drug. 

Temperature. — Excessive doses result in a fall of temperature. 
According to Schlager, a thermal rise succeeds the hypodermic 
injection of the drug, due probably to local irritation. 

Poisoning. — While fatal results from the ingestion of large doses 
are recorded, the toxic effects of eucalyptus are practically confined 
to the lower forms of animal and vegetable life — infusoria, crypto- 
gamia, etc. In Gimbert's experiments upon animals it was noted 
that the heart continued to beat for some time after respiration had 
ceased; from which it may be concluded that, since the motor 
nerves and muscles retained their functional activity after death, 



ANTISEPTICS. 343 

failure of mobility and reflex power is due to central action, the 
drug in toxic doses being a paralyzant to the spinal cord and the 
medulla. 

Drowsiness, shallow breathing, cardiac weakness, and reduced 
arterial pressure are common results of poisonous doses of euca- 
lyptus. 

Treatment of Poisoning. — The stomach should be emptied, and 
the treatment should include the administration of alkalies or some 
preparation of iron, eliminants, strychnine, coffee, and diffusive 
stimulants. 

Therapeutics. — The author is indebted to Prof. G. Frank Lyds- 
ton, M. D., for the following communication in regard to the thera- 
peutics of this drug. Dr. Lydston's experience with the remedy, 
having been very extensive, lends to his statements authoritative 
weight ; he is therefore quoted verbatim : 

" Eucalyptus is, in my experience, a most valuable remedy in 
chronic inflammation of mucous membranes. In nasopharyngeal 
catarrh it is of especial value. It may be used either in the form 
of spray or a thin ointment. If used as a spray, it should be com- 
bined with albolene or liquid vaseline in the proportion of 15 to 
20 drops (0.92-1.23 Cc.) of the oil of eucalyptus to the ounce 
(30 Cc.) of menstruum. The strength may be considerably in- 
creased as tolerance is established. The most eligible preparation 
in the form of ointment is a combination of oil of eucalyptus with 
lanoline, sufficient albolene being added to Hquefy the ointment. 
The eucalyptus may be used in this manner in a strength of 30 to 
60 minims (1.84-3.7 Cc.) to the ounce (32.0 Gm.). The action of the 
eucalyptus is mildly stimulant and astringent and decidedly anti- 
septic. 

*' Eucalyptus has proven of value in my hands as a local applica- 
tion in acute and chronic skin diseases. In simple dermatitis a mild 
ointment of eucalyptus is quite efficacious. In chronic affections, 
such as some forms of eczema and psoriasis, a strong ointment of 
eucalyptus, or even the pure oil itself, may in some cases be 
applied with great benefit, 

** Eucalyptus is also valuable in the treatment of sluggishly 
granulating wounds and idcers. In g astro-intestinal diseases euca- 
lyptus is of great value. It is a gastro-intestinal antiseptic of 
great merit, and one which should be more generally used. In 
certain forms of diarrhea due to the development of toxines in the 
gastro-intestinal tract the drug is a most valuable remedy. It has 



344 A TEXT-BOOK OF MATERIA MEDIC A. 

the merit of marked antiseptic action without sufficient astringent 
effect to interfere with the normal method of ehmination by the 
bowel. In typhoid fever eucalyptus is in my opinion more strongly 
indicated than any other drug. Inasmuch as salol has such an 
enviable reputation as an intestinal antiseptic, it might be well to 
suggest that the oil of eucalyptus may be with propriety combined 
with that drug. I have used the eucalyptus alone and combined 
with salol, and am satisfied that either way is better than the use 
of the salol alone. 

" It has been my fortune to have a moderately extensive expe- 
rience in the use of eucalyptus in malarial affections. Diseases of 
malarial origin are infrequently met with in Chicago and its im- 
mediate environs, but in the New York hospitals at the time I was 
serving as interne typical malarial affections were abundant. I ex- 
perimented at that time quite extensively with eucalyptus, and 
found that the drug was not to be relied upon in distinct attacks 
of acute ague, but that it was of considerable value in the chronic 
forms and in the peculiar lassitude and depression with which 
patients who were not affected with typical malarial exacerbations 
often suffered. 

"After some years' experimentation with eucalyptus I have 
become convinced that its most valuable property is that of a 
urinary antiseptic. I take the opportunity of repeating here what 
I have repeatedly said elsewhere, that eucalyptus is the most 
reliable urinary antiseptic at our command. Careful experimenta- 
tion and clinical observation have shown me that in eucalyptus we 
have a remedy which greatly lessens the dangers of genito-urinary 
surgery by lessening or entirely removing the septic property of 
the urine, that bete 7ioire of the andrologist. Boric acid and salol 
have in my experience been disappointing, while eucalyptus has 
exceeded my anticipations. My method of administration is by 
capsule, lo minims (0.6 Cc.) of the oil being given four tim^es daity, 
beginning several days before the operation. The only disadvan- 
tage attending the use of eucalyptus is gastric intolerance on the 
part of a few patients. As a rule, the remedy is taken without 
complaint, but occasionally disagreeable eructations or even vomit- 
ing occurs. By preceding the remedy with a large draught of milk 
this objection may usually be done away with. In some cases sus- 
pension of the remedy for a few hours will enable the stomach to 
acquire the desired toleration. 

" In the administration of eucalyptus much depends upon the 



ANTISEPTICS. 345 

preparation used. Without the slightest desire to advocate unduly 
any special preparation, but simply as a matter of information to 
the profession, I will state that in my experience the preparations 
known as Tyndale's are the most reliable and elegant upon the 
market. These preparations comprise an aqueous solution, an 
ointment, and an oil, the latter of which is in daily use in my 
practice." 

The foregoing quotation expresses so clearly the uses of euca- 
lyptus that further details appear unnecessary. The antiseptic 
properties of the drug are not sufficiently realized by many physi- 
cians. Schultz claims that eucalyptus as an antiseptic is three 
times as powerful as carboHc acid, and that as an agent to arrest 
suppuration it is perhaps fully equal to quinine. 

As a stimulant expectorant eucalyptus is of great value, equal- 
ling, if not being superior to, any other remedy in bronchorrhea, 
pulmonary gangraie, and fetid bronchitis, associated or not with 
phthisis. Chronic or catarrhal conditions of the lungs and bronchi 
only are benefited by eucalyptus, acute affections of the broncho- 
pulmonary mucous membrane contraindicating its use. A solution 
of oil of eucalyptus is used as an antiseptic inhalation in diphtheria. 

Administration. — The fresh leaves may be employed as poul- 
tices. Any of the preparations may be used, but for internal pur- 
poses the oil, or eucalyptol, is preferable, although a good fluid 
extract is an agreeable form of the medicine. The oil, or euca- 
lyptol, may be given in an emulsion or in capsules, for topical use 
being diluted with alcohol or oil or incorporated in suppositories or 
ointments. 

Sodii Boras— Sodii Boratis— Sodium Borate. 

V. S. JP. 

(Borax.) 

Orig-in. — Prepared by boiling together solutions of Boric Acid 
and Sodium Carbonate, the borax crystallizing out. It is also found 
in a native state on the shores of certain lakes and as a crystalline 
deposit in the Borax Lake of California. 

Description and Properties. — Colorless, transparent, mono- 
clinic prisms, or a white powder, inodorous, and of a sweetish, 
alkaline taste; sHghtly efflorescent in warm, dry air; soluble in i6 
parts of water and in i part of glycerin ; insoluble in alcohol. 

Dose. — 5-30 grains (0.32-2.0 Gm.). 



346 A TEXT- BOOK OF MATERIA MEDIC A. 

Acidum Boricum— Acidi Borici— Boric Acid. Z7. S. P« 

(BoRACic Acid.) 

Origin. — Found native in Northern Tuscany. It may be pre- 
pared by the action of Hydrochloric Acid on Borax, filtration, and 
recrystallization. 

Description and Properties. — Transparent, colorless scales, of 
a somewhat pearly luster, or, when in perfect crystals, six-sided, 
triclinic plates, slightly unctuous to the touch, odorless, of a faintly 
bitterish taste, permanent in the air. Soluble in 25.6 parts of 
water, 15 parts of alcohol, and 10 parts of glycerin. The addition 
of hydrochloric acid increases its solubility in water. 

Dose. — 5-15 grains (0.32-1.0 Gm.). 

Official Preparation. 

Glyceritum Boroglycerini — Glyceriti Boroglycerlni— Glycerite of Boro- 
glycerin (Glycerite of Glyceryl Borate — Solution of Boroglyceride). — 
Boric Acid, 310; Glycerin, to looo. For external use. 



Antagonists and Incompatibles. — The incompatibles of borax 
are the acids and metallic salts. Morphine and cocaine are pre- 
cipitated from solution by borax. Boric acid is also incompatible 
with the carbonates and bicarbonates, and with the alkaline, earthy, 
and metallic bases. 

Synergists. — The action of borax is enhanced by alkalies and 
substances promoting waste ; that of boric acid, by the anti- 
septics. 

Physiolog-ical Action. — Exterjially and Locally. — Borax is ab- 
sorbent, protectant, sedative, and antiseptic. Applied to the un- 
broken skin, it acts upon the epidermis as a soap. By removing 
the stimulus to secretion and lessening irritation borax checks the 
secretion of the salivary glands. 

Boric acid possesses properties similar to those of borax, 
although more of an antiseptic and antipruritic. It has also an 
exsiccant and detergent influence. 

Internally. — In a general way the action of borax is analogous 
to that of the alkalies. It is refrigerant and diuretic, and by its 
immediate action upon the womb serves as an emmenagogue, large 
doses contracting the uterine muscles and acting as an ecbolic. 
Excessive doses of either of these drugs act as gastro-intestinal 
irritants. 

Boric acid, though stronger, resembles borax in its action. Both 



ANTISEPTICS. 347 

substances, especially boric acid, retard the action of saliva upon 
starch, increasing that of the pancreatic juice upon albuminous 
substances, and increase gastric digestion. Immoderate doses of 
BORIC ACID check gastric digestion. 

The drug is a moderate antipyretic, and when injected in large 
amounts into the circulation may occasion paralysis of the motor 
nerves and muscles. 

Absorption mid Elimination. — It is eliminated by the saliva, per- 
spiration, feces, and urine, the latter being increased in quantity. 
The amount of nitrogen and soHd matter excreted with the feces 
is also increased, as well as the elimination of urea in the urine. 
Uiitoward Action. — Boric acid has occasioned the following 
untoward symptoms : frequent desire to micturate ; nausea, vom- 
iting, and other gastric disturbances ; small, weak pulse ; derange- 
ment of the nervous system ; hiccough ; and various cutaneous 
eruptions. 

Poisoning. — The symptoms of poisoning are analogus to those 
described above. 

Treatment of Poisoning. — The treatment of poisoning should 
be symptomatic, stimulants, morphine, etc. being employed. 

Therapeutics. — Externally and Locally. — Both of the above 
drugs are exceedingly valuable as local remedies in the treatment 
of many disorders of the ear, nose, and throat, such as acute and 
chronic nasal catarrh, pharyngitis, gingivitis, and acute Jioarseness. 
An efficient domestic remedy in aphthce affecting the mouths of 
nursing children is a mixture of borax and honey. 

An invaluable aseptic application in acute conjunctivitis is a sat^ 
urated solution of boric acid. 

Leucorrhea, gonorrhea, and chro7iic cystitis are greatly benefited 
by solutions, in various strengths, of either or both of these drugs. 
Sir James Simpson recommends a solution of borax, 5-10 grains 
(0.32-0.6 Gm.) to I ounce (30.0 Cc.) of hot water, for the eruption 
occurring on the mucous membrane of the vulva in young girls. 

Since the introduction of boric acid as an antiseptic by Lister in 
1872 it has steadily grown in favor in this respect, being univer- 
sally employed to-day, both in solution and in the powdered form, 
for the numerous conditions requiring an agent of this character. 
It is invaluable as a bland, unirritating antiseptic in general surgery, 
and in diseases of the eye, ear, nose, throat, and skin. 

It is perhaps unnecessary to enumerate the multifarious and 
efficient uses of this drug, the practising physician readily recog- 



348 A TEXT-BOOK OF MA TERIA MEDICA. 

nizing the conditions in which this potent remedy may be advan- 
tageously employed. 

Internally. — Borax is used internally more than boric acid. 
While in epilepsy inferior to the bromides, there are cases uninflu- 
enced by the latter remedies which respond favorably to borax. 

The drug has been employed in typhoid fever, though with little 
benefit. Dr. Sacaze of Montpelier claims to have greatly improved 
a case of paralysis agitans with 4- to 8-grain (0.25-0.51 Gm.) 
doses, given three times a day. 

The author has favorably influenced the character of the urine 
in chronic cystitis by 5 -grain (0.3 Gm.) doses of boric acid three 
times a day. 

These drugs have been used internally in the summer diarrhea 
of children. 

Administration. — The remedies may be given in capsules or 
solution. The taste of borax may be disguised by coffee, syrup of 
orange, or aromatic elixir of liquorice, the drug not being admin- 
istered with glycerin, lest an acid reaction occur. 

Potassii Permanganas— Potassii Permanganatis— 
Potassium Permanganate. TJ. S. J*. 

Orig-in. — Obtained by heating together Caustic Potash, Potas- 
sium Chlorate, and Manganese Dioxide. The potassium manga- 
nate formed is converted into the permanganate by boiling it in 
water. 

Description and Properties. — Slender, monoclinic prisms, of 
a dark-purple color, almost opaque by transmitted light, and of a 
blue, metallic luster by reflected light ; odorless, with at first a sweet 
and afterward a disagreeable and astringent taste ; permanent in the 
air; soluble in 16 parts of water. In contact with alcohol it is 
decomposed. 

Potassium permanganate should be kept in glass-stoppered bot- 
tles, protected from Hght, and should not be brought in contact 
with organic or readily oxidizable substances. 

Dose. — ^-2 grains (0.03-0.12 Gm.), as a pill. 

Antagonists and Incompatibles. — Organic matter easily deox- 
idizes it, causing an explosion. 

Synergists. — Theoretically, the antiseptics would enhance its 
antiseptic action. 

Physiological Action. — Potassium permanganate is employed 
as an antiseptic and oxidizing agent in certain diseases, both the 



ANTISEPTICS. 349 

internal and external use of the drug having proved beneficial. 
The peculiar property of the remedy is its readiness to part with 
oxygen, and its consequent availability as an agent in the destruc- 
tion of deleterious organisms. Brunton asserts that " when mixed 
with cobra-poison it completely destroys the deadly power of the 
latter, and the mixture may be injected subcutaneously without 
any bad effect," though he adds that as an antidote it is unservice- 
able, since it does not come in contact with the venom in the tissues. 

In rare instances, it is asserted, potassium permanganate has 
occasioned a vesicular eruption not unlike eczema. It is at times 
decidedly caustic. 

Therapeutics. — Externally and Locally, — In concentrated solu- 
tions or in substance it is a mild escharotic. Its readiness to part 
with ogygen renders it of great value as a deodorant, and in dilute 
solutions, I to 5 grains (0.06 to 0.32 Gm.) to i ounce (30 Cc.) of 
water, it is a useful application to foul ulcers, cancer of the uterus, 
vagina, etc. A solution of this drug is employed for various pur- 
poses as an antiseptic, germicide, and deodorant, in the treatment 
of gonorrhea, leucorrhea, diphtheria, putrid sore throat, ozena, naso- 
pharyngeal catarrh, cancer of the tongue, and syphiltic idcers. 

A weak solution of potassium permanganate is an efficient ap- 
plication in bromidrosis, and a i : 2000 or i : 5000 solution is recom- 
mended by Dr. Terson in purulent ophthabnia. Potassium per- 
manganate should not be used as an antiseptic in the peritoneal 
cavity, on account of its irritating properties. It is employed 
extensively in surgical practice for washing the hands and utensils. 

Internally. — Like iron, potassium permanganate has been em- 
ployed in anemia, although far inferior to the former drug. Favor- 
able reports are given regarding its value in gastric fermentation 
and lithiasis. 

Dr. Moor of New York recently advocated its use as an anti- 
dote to morphine-poisoning. It seems to form a chemical substance 
with morphine which is circulating in the blood, rendering the lat- 
ter inert. The drug has, therefore, been considered by some author- 
ities a true physiological antagonist in morphine-poisoning, whether 
administered hypodermically or by the mouth. Other authorities 
claim that it is but a chemical antagonist for morphine, being active 
only when brought in actual contact with the poison. 

Dr. Moor claims, however, that potassium permanganate does 
not possess the same antidotal power over certain other alkaloids, 
such as strychnine, atropine, cocaine, aconitine, etc. Antal, on the 



350 A TEXT-BOOK OF MATERIA MEDIC A. 

other hand, maintains that the drug is equally serviceable in mor- 
phine- and strycJmine-, as well as muscarine-, poisoning, and in that 
resulting from toxic doses of colchicuni and oxalic acid. Dr. Koosa 
believes it to be also efficient in poisoni?ig from hydrocyanic acid, 
and Dr. Hognos reports very favorably as to its antidotal power in 
poisoning from phosphorus, having treated two cases successfully 
with this remedy. 

Recently, Dr. Fr. Lanz reports interesting statistics of Prof, 
von Jaksch's clinic in which phosphorus-poisoning was treated 
with douches of potassium permanganate, the death-rate, however 
— 36.66 per cent. — not speaking very favorably for the antidotal 
power of the drug in connection with phosphorus. 

Administration. — For internal use potassium permanganate 
should always be given in pill form, kaoHn being used as an 
excipient, lest an explosion occur. 

Potassii Bichromas— Potassii Bichromatis— Potas- 
sium Bichromate. JJ,S,I*. 

Orig-in. — Prepared by roasting in a reverberatory furnace Potas- 
slum Carbonate and Chrome-iron Ore, with the addition of Lime 
or Chalk to prevent fusion. The potassium bichromate formed is 
separated by crystalHzation from its solution in water acidulated 
with sulphuric acid. 

Description and Properties. — Large orange-red, transparent 
triclinic prisms or four-sided tables, odorless, and having a bitter, 
metalhc taste. Permanent in the air; soluble in 10 parts of water; 
insoluble in alcohol. 

Dose. — T^-i grain (0.0006-0.06 Gm.). 

Antagonists and Incompatibles. — Potassium bichromate is in- 
compatible with soluble salts of silver, mercury, and lead, and 
with Hquor potassae, liquor sodae, and ammonia water. 

Ssmergists. — Agents promoting waste, antiseptics, and caustics. 

Physiolog-ical Action. — Externally and Locally. — In substance 
potassium bichromate is an irritant caustic, and, according to 
Miquel, an antiseptic in the proportion of i to 909. 

Internally. — Its action is nearly identical with that of potassium 
chlorate, with the additional properties of an expectorant, emetic, 
and mild alterative. 

Poisoning and treatment of poisoning do not differ essentially 
from those of potassium chlorate. 

Therapeutics. — Externally and Locally. — Potassium bichromate 



ANTISEPTICS. 351 

is used as a caustic for warts, corns, cJiancres, chancroids, mucous 
patches, etc., and is also of considerable value as a gargle in 
pharyngitis. 

Internally. — Frazer has recently recommended this drug in the 
treatment of dyspepsia and gastric ulcer, claiming that the pain, 
nausea, vomiting, and tenderness may be readily allayed by doses 
of j^ to -I" grain (0.005-0.01 Gm.), taken upon an empty stomach 
three times a day. In actite gastric tdcer he has perceived no 
benefit so far as its effect upon the hemorrhage is concerned, the 
most desirable action of the drug in the latter condition being 
derived from its antiseptic and analgesic influence. 

The author desires to recommend favorably potassium bi- 
chromate, in doses of -j-J-q grain (0.0006 Gm.) every hour or two, in 
aphonia and hoarseness due to excessive action of the vocal cords 
or resulting from an acute cold. He has found this method of 
treatment pecuHarly and speedily efficacious. 

Potassii Chloras— Potassii Chloratis— Potassium 
Chlorate. U. S. JP. 

Origin. — Prepared by passing Chlorine into a mixture of Potas- 
sium Carbonate and Slaked Lime. By subsequent boiling in 
water the chlorate separates by crystallization. 

Description and Properties. — Colorless, lustrous, monoclinic 
prisms or plates, or a white powder, odorless, and having a cool- 
ing, saline taste; permanent in the air; soluble in 16.7 parts of 
water ; insoluble in absolute alcohol. Potassium chlorate should be 
kept in glass-stoppered bottles. Great caiition shoidd be observed 
in handling the salt, since dangerous explosions are liable to occur 
when it is mixed with organic matters — cork, tannic acid, sugar, 
etc. — or with sulphur, antimony sulphide, phosphorus, or other 
easily oxidizable substance, or upon being either heated directly or 
subjected to trituration or concussion. 

Dose. — 3-20 grains (0.2-1.3 Gm.). 

Official Preparation. 

TrocMsci Potassii Chloratis — Trochiscos (ace) Potassii Chloratis — 
Troches of Potassium Chlorate. — Each troche contains 5 grains (0.32 Gm). 
Dose, I to 4 troches. 

Antagonists and Incompatibles. — In addition to those sub- 
stances mentioned above with which potassium chlorate forms 



35^ A TEXT-BOOK OF MATERIA MEDICA. 

explosive compounds, mixture with glycerin and the hypophos- 
phites is liable to produce similar dangerous results. 

Synergists. — Agents promoting waste increase the activity of 
the drug. 

Physiolog'ioal Action. — Externally and Locally. — It is slightly 
detergent and stimulant, antiseptic and astringent, being irritant 
when applied in concentrated solution to ulcerated surfaces. 

hiternally. — Digestive System. — Medicinal doses have no effect ; 
poisonous doses excite violent gastro-intestinal irritation, nausea, 
bloody vomiting, diarrhea, and jaundice. 

Circulatory System. — Small doses of potassium chlorate tend 
to depress and subsequently raise arterial tension, accelerating the 
pulse ; large doses lower arterial pressure alarmingly ; toxic doses 
convert the hemoglobin of the blood into methemoglobin, the dis- 
organized fluid appearing in the urine. Post-mortem lesions are — 
enlargement of the liver, spleen, and kidneys, with evidences of 
marked inflammation over the whole intestinal tract. 

Nervous System. — Medicinal doses are inert. Toxic doses may 
produce dehrium and death, preceded by coma or convulsions. 

Respiratory System. — Large doses act as a depressant to the 
respiratory apparatus. 

Absorption and Elimination. — The drug is absorbed with con- 
siderable rapidity, being chiefly eliminated by the salivary glands 
unchanged. The drug does not increase the urinary flow, large 
doses, on the contrary, tending to suppress it. 

Temperature. — Unaffected by medicinal doses, but lowered by 
toxic amounts. 

Untoward Action. — Small doses of potassium chlorate seldom 
produce untoward symptoms, although in rare instances eruptions 
of an erythematous, papular, or vesicular nature have followed the 
use of the drug. Digestive disturbances occasionally ensue, with 
pain in the region of the kidneys and albuminuria. 

Poisoning. — In the few recorded cases of poisoning there were 
observed a continuous sensation of choking, excessive thirst, per- 
sistent vomiting, pain in the abdomen and renal tract, and violent 
hiccough. Accompanying symptoms were — a small and rapid 
pulse and faintness, while the urine was albuminous and diminished 
in quantity ; epistaxis was present ; the eyes and lips were cyanotic, 
and the skin slightly jaundiced and markedly anemic; the liver and 
spleen were slightly enlarged ; and there were alternating sensations 
of cold and heat, with drowsiness ending in coma and death. 



ANTISEPTICS. 353 

Treatment of Poisoning. — The stomach should be emptied as 
quickly as possible and demulcents administered. The patient 
should be treated symptomatically, and it may be advisable to 
practice venesection, followed by transfusion of blood, as suggested 
by Landerer. 

Therapeutics. — Externally and Locally. — A solution of this 
drug has been applied with some success in foul ulcers and moist 
eczema. Like the potassium permanganate, it has been employed 
in various diseases of tJie nose and throat, and is especially service- 
able in ptyalism and aphthotis ulceratiojt. As a remedy for syphilitic 
miicoiLS patches and herpes of the buccal cavity it is of considerable 
value. It is more efficient in acute than in chrofiic pharyjigitis . 

It possesses marked cicatrizing power, advantage of which 
property has been taken in the treatment of phagedenic sores, the 
powdered drug being used for this purpose. It is thought that ene- 
mas of potassium chlorate solution favor the healing of rectal ulcers. 

htternally. — As a remedial agent this drug has not met with the 
success prophesied by many physicians. Dr. Coghill of England 
is one of its most enthusiastic champions, the drug having proved 
in his hands highly efficient in improving the quality of the blood 
in such cases as simple anemia, chlorosis, etc., as well as in "pul- 
monary insufficiency" and "deficient oxygenation of the blood." 
Other physicians have recommended it as a valuable galactagogue, 
tonic, and alterative, and as beneficial in> certain chronic diseases of 
the skin, scrofda, etc. It has found some advocates as a genito- 
urinary antiseptic and as a remedy in typhoid fever. 

Yet, notwithstanding the extravagant, though isolated, reports 
concerning the great value of the drug, its utility, has not been 
universally recognized ; indeed, so good an authority as Marchand 
declares that " chlorate of potassium should be entirely rejected in 
practice, and particularly in the treatment of children." 

Administration. — It may be given in the form of troches, 
powder, tablets, or a solution, an agreeable means of administra- 
tion being in aerated water. Owing to its tendency to decomposi- 
tion when combined with other substances, the drug should be 
prescribed alone. 

Aqua Hydrogrenii Dioxidi— Aquae Hydrogenii Diox- 
idi— Solution of Hydrogen Dioxide. 77. S. JP. 

Origin. — A slightly acid, aqueous solution of hydrogen diox- 
ide, containing, when freshly prepared, about 3 per cent, by weight 

23 



354 A TEXT-BOOK OF MA TERIA MEDICA. 

of the pure dioxide, corresponding to about lo volumes of avail- 
able oxygen. 

Description and Properties. — A colorless liquid, without odor, 
slightly acidulous to the taste, and producing a peculiar sensation 
and a soapy froth in the mouth ; liable to deteriorate with age or 
by exposure to heat or protracted agitation. 

Dose. — 1-4 fluidrachms (3.7-15.0 Cc), well diluted with water. 

Physiological Action. — Externally and Locally. — The principal 
action of this preparation seems to be its property of imparting 
oxygen to all oxidizable substances, it being one of the most pow- 
erful oxidizing agents in Materia Medica, and therefore an exceed- 
ingly active non-toxic antiseptic. 

When applied to a suppurating surface, or when mixed with 
mucus, cerumen, or blood, active effervescence is produced. Hy- 
drogen dioxide is a useful detergent and bleaching agent, being 
employed largely for the purpose of bleaching hair and deUcate 
fabrics. 

Internally. — It is asserted that hydrogen dioxide yields oxygen 
to the blood, sHghtly stimulates the nervous system, and acts as a 
diuretic. 

Therapeutics. — Externally and Locally. — Hydrogen dioxide is 
extensively employed to cleanse diseased surfaces, such as ulcers^ 
buboes, Jisttdons tracts, etc. It has been highly recommended as an 
antiseptic in abdominal surgery. As an antiseptic wash in empyema, 
cystitis, joint-cavities, venereal sores, puerperal septic endometritis, etc. 
hydrogen dioxide is an exceedingly valuable agent. 

Hydrogen dioxide appears to be an efficient injection in gonor- 
rhea, and is much used as an antiseptic in many diseases of the 
eye, ear, nose, and throat. It has been highly recommended as a 
solvent for diphtheritic membrane, although when frequently applied 
to the throat it causes an unpleasant sensation of dryness, and it 
seems to prevent the exfoliation of the membrane when the patient 
is treated with antitoxine. 

Hydrogen dioxide serves a useful purpose in disinfecting drink- 
ing-water when suspected of pollution, i part sufficing for 1000 
parts of water, in which amount the taste or other potable quali- 
ties of the water are in no way impaired. 

Interjtally. — While hydrogen dioxide has been recommended 
in epilepsy, diabetes, angina pectojHs, pneumoitia, asthma, and dyspnea 
due to deficient circulation of blood through the heart and lungs, 
the results following the internal administration in these diseases 



ANTISEPTICS. Z^S 

have not warranted classing the drug among important internal 
medicines. 

Administration. — For external and local use the drug may be 
gargled, sprayed, or applied with a syringe or a swab, either in full 
strength or diluted with water. Whether for external or internal 
use, the solution should be freshly prepared ; when given internally 
it should be taken from a porcelain or china, not a metal, cup or 
spoon. 

Acidum Sulphurosum— Acidi Sulphur5si— Sulphur- 
ous Acid, u.s.r. 

Orig-in. — A liquid composed of not less than 6.4 per cent, by 
weight of Sulphurous Acid Gas (Sulphur Dioxide) and not more 
than 93.6 per cent, of Water. 

Description and Properties. — A colorless liquid, of the cha- 
racteristic odor of burning sulphur, and of a very acrid, sulphur- 
ous taste. It should be kept in dark-colored, glass-stoppered 
bottles, in a cool place, and protected from light. 

Dose. — J-2 fluidrachms (1.8-7.39 Cc). 

Physiological Action. — Externally and Locally. — Sulphurous 
acid is a powerful deoxidizing agent, the fumes of burning sulphur 
having been employed centuries ago to disinfect temples, dwellings, 
etc. It easily abstracts oxygen from organic bodies, the acid, in 
short, being a powerful disinfectant, antiseptic, deodorant, and 
parasiticide. 

Internally. — The disinfecting properties of sulphurous acid are 
less apparent when the drug is ingested than when it is used 
externally. 

Therapeutics. — Exteimally and Locally. — As an antiseptic, dis- 
infectant, and deodorant sulphurous acid may be employed in the 
treatment of various parasitic skin diseases, and a solution of sul- 
phurous acid affords an efficient application to the throat in pharyn- 
gitis, particularly the gangrenous form, diphtheria, etc. 

According to Dujardin-Beaumetz, Sollaud, and Balbaud, non- 
febrile pidmonary phthisis is often favorably influenced by the daily 
inhalation for a short time of sulphurous-acid vapor. This dis- 
agreeable, not to say dangerous, method of treatment has neither 
been generally adopted nor proved to be of established efficacy. 

The acid is a useful antiseptic to apply to recent wounds, and 
may be employed to disinfect the dejections of the sick, the fumes 



356 A TEXT-BOOK OF MATERIA MEDICA. 

from burning sulphur also being serviceable to disinfect rooms and 
bedding tainted with infectious disease. 

Internally. — Sulphurous acid is seldom used internally, though, 
owing to its powerful antifermentative properties, it has been em- 
ployed in so-called fermentative dyspepsia, intestinal fermentation, 
and urticaria. While it checks fermentation in the laboratory, its 
effect is less certain in the body ; nor can the internal administra- 
tion of the drug be regarded as satisfactory. 

Administration. — Sulphurous acid should be given well diluted 
with water. 

Sodii Suiphis— Sodii Sulphltis— Sodium Sulphite. 

(7. 8. JP. 

Origin. — Prepared by saturating a solution of Sodium Carbon- 
ate or Caustic Soda with Sulphur-dioxide Gas. 

Description and Properties. — Colorless, transparent, mono- 
cHnic prisms ; odorless, and having a cooling, saline, sulphurous 
taste. In the air the salt effloresces and is slowly oxidized to sul- 
phate. Soluble in 4 parts of water ; sparingly soluble in alcohol. 
It should be kept in well-stoppered bottles, in a cool place. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Sodii Bisulphis— Sodii Bisulphitis— Sodium Bisul- 
phite. U. S. J>. 

Orig-in. — Prepared from Sodium Carbonate or Bicarbonate and 
Sulphur Dioxide. 

Description and Properties. — Opaque, prismatic crystals, or a 
granular powder, exhaling an odor of sulphur dioxide, and having 
a disagreeable, sulphurous taste. Exposed to the air, the salt loses 
sulphur dioxide and is gradually oxidized to sulphate. Soluble in 
4 parts of water and in 72 parts of alcohol. The drug should be 
kept in a cool place, in small, well-stoppered bottles filled as full as 
possible. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Sodii Hyposulphis— Sodii Hyposulphitis— Sodium 
Hyposulphite. IT. S. JP. 

Origin. — Prepared by passing Sulphurous Anhydride into a 
solution of Sodium Carbonate with Salts. 

Description and Properties. — Colorless, transparent, mono- 
cHnic prisms ; odorless, and of a cooling, afterward bitter, taste. 



ANTISEPTICS. Z^-J 

Soluble in 0.65 part of water ; insoluble in alcohol. It should be 
kept in well-stoppered bottles. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Physiolog'ical Action and Therapeutics of Sodium Sulphite, 
Bisulphite, and Hyposulphite. — These substances are feeble ger- 
micides and antiseptics, checking putrefaction and other forms of 
fermentation. It is supposed that they are decomposed in the 
stomach, liberating sulphurous anhydride ; on which assumption 
they have been given to arrest gastric fannentation and as reme- 
dies in typhoid and yellozv fevers, diphtheria, erysipelas, etc. The 
hypothesis, however, upon which they have been thus hopefully 
employed has not been confirmed by clinical experience. 

These drugs have nevertheless proved efficacious in the treat- 
ment of scabies, sycosis, impetigo, f aims ^ etc. Atomized solutions 
of sodium hyposulphite inhaled are beneficial in ga^igrene of the 
lungs, fetid broncJiitis, etc. 

Administration. — The foregoing preparations of sulphur may 
be given in solution or in this form applied topically. The sodium 
hyposulphite may also be applied in the form of an ointment. 

Aqua Chlori— Aquae Chlori— Chlorine Water. 

77. H.- JP. 

Origin. — An aqueous solution of Chlorine, containing at least 
0.4 per cent, of the gas. 

Description and Properties. — A clear, greenish-yellow liquid, 
having the suffocating odor and disagreeable taste of chlorine, and 
leaving no residue on evaporation. Chlorine water, even when 
kept from light and air, is apt to deteriorate ; when it is required 
of full strength, it should be freshly prepared. 

Dose. — 1-4 fluidrachms (3.7-1 5.0 Cc). 

Antagonists and Incompatibles. — The salts of lead and silver 
are incompatible. 

Synergists. — The antiseptics are theoretically synergistic, 
though practically the drug is almost always used alone. 

Physiological Action. — Externally and Locally. — Chlorine 
water is a powerful antiseptic, germicide, and deodorant. When 
applied to the skin it acts as a rubefacient and vesicant, while the 
vapor is quite irritating to the respiratory passages. 

Internally. — Chlorine water is more or less irritating to the 
mucous membrane of the stomach, and possesses an astringent 
taste. . 



35^ A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — Chlorine water is still 
occasionally used as an antiseptic and deodorant in gangrenous or 
sloughing wounds diud for (XismiQcXAngfotd discharges, q\.c. It has 
proved beneficial as a local application in aphthous stomatitis, diph- 
theria, and parasitic skin diseases. 

Internally. — Chlorine water is so seldom employed internally 
that its use in this respect scarcely requires comment. 

Administration. — When given internally the drug should be 
well diluted. Should poisoning ensue from the ingestion of exces- 
sive amounts, albumen is the best antidote ; for the irritation occa- 
sioned by the inhalation of chlorine gas steam-inhalations are 
indicated. 

Calx Chlorata—CalcisChloratae— Chlorinated Lime. 

V. S. JP. 

("Chloride of Lime.") 

Orig-in. — A compound resulting from the action of Chlorine 
upon Calcium Hydrate, and containing not less than 35 per cent. 
of available Chlorine. 

Description and Properties. — A white or grayish-white, granu- 
lar powder, exhaling the odor of hypochlorous acid ; of a repulsive 
sahne taste, and becoming moist and gradually decomposing on 
exposure to air. It is but partially soluble in water or alcohol. 
The drug should be kept in well-closed vessels, in a cool and dry 
place. Used externally. 

Physiological Action and Therapeutics. — Chlorinated lime is 
a powerful disinfectant, yielding, when exposed to air, hypochlorous 
acid, which is resolved into chlorine and chloric acid, the last in 
turn yielding chlorine. 

The effects of the drug are therefore analogous to those of 
chlorine, yet almost the only use which chlorinated lime serves is 
in disinfecting cesspools and utensils employed for the dejections 
of invalids. 

Liquor Sodae Chloratae— Liquoris Sodae Chloratae— 
Solution of Chlorinated Lime. U. S. ^. 

(Labarraque's Solution.) 

Origin. — An aqueous solution of several chlorine compounds 
of Sodium, containing at least 2.6 per cent, by weight of available 
chlorine. 



AROMA TICS. 359 

Description and Properties. — A clear, pale-greenish liquid, 
having a faint odor of chlorine and a disagreeable alkaline taste. 
It should be kept in well-stoppered bottles, protected from light. 
Used externally. 

Physiological Action. — The action of the drug resembles that 
of aqua chlori, although it is feebler than the latter. 

Therapeutics. — Solution of chlorinated soda is used as a disin- 
fectant iox fetid ulcers, gangrenous sores, and ozena, and as a disin- 
fectant wash in diseases of the nteriis, vagina, and auditory canal. 

Administration. — There are no special directions to be ob- 
served in the application of this solution. 



AROMATICS. 

The following-named drugs, classed by some authors as aro- 
matics, are not only active antiseptics and antispasmodics, but 
possess properties very similar to those of the more typical anti- 
septics, antipyretics, and anesthetics. These antiseptic properties 
of aromatic drugs are well known to modern science, and, what is 
of unique interest and significance, were perfectly famiHar to the 
ancients, who could not possibly divine the scientific value of the 
virtues familiarized only by the crudest empiricism. In the custom 
of the Egyptians of embalming the dead we have a remarkable 
example of their divination of antisepsis in the perfumes and spices 
in which their dead were buried ; and in the Christian Gospel we 
read of Nicodemus that he " brought a mixture of myrrh and 
aloes," and that they " took the body of Jesus, and wound it in 
linen cloths with the spices, as the manner of the Jews is to bury " 
(John xix. 39, 40). 

Apart, however, from the remarkable testimony of the fore- 
going examples, these peculiar properties of aromatic herbs appear 
to have been established in all succeeding ages. Especially among 
the Greeks were the medicinal virtues of certain aromas recognized, 
recipes for celebrated healing essences being inscribed on marble 
tablets in their temples. Among the Romans, too, the custom pre- 
vailed of mingling sacred aromatic ingredients with the ashes of 
the departed — a usage not wholly to be regarded as a religious 
ceremony, but rather as a recognition of the properties ascribed to 
these agents by their Athenian neighbors. 

Indeed, the history of perfumes teems with illustrations of the 



360 A TEXT-BOOK OF MATERIA MEDIC A. 

common faith in their heaKng power, though from the derivation 
of the word — per, through, and funmm, smoke — the offering of 
incense, by burning aromatic woods, spices, and gums, seems to 
have been the original use suggested by them. This conception 
of the sacred and purifying influence of aromas is seen to-day in 
the censer of the rituahstic churches, as it may be traced from 
earliest recorded times through the centuries that intervene. 

The more secular regard for aromatic herbs, however, rests 
rather upon a rational, though unscientific, observation of facts 
than upon hierarchical assumption. It is recorded, for instance, 
that while cholera raged in Paris and London the gentle office in 
which they were engaged secured to the perfumers immunity from 
the plague, and that when the Dutch on the island of Ternate 
destroyed the clove tree the colony suffered from epidemics and 
disorders unknown before. 

The property of absorbing malaria generally ascribed to the 
leaves of Eucalyptus globtdus is a further illustration of the 
medicinal uses of aromatic plants, this tree being considered a 
potent febrifuge. Witness also the beneficial results of planting 
this tree in the Roman Campagna. 

Even the refined taste and delicacy of sense which have per- 
petuated the "perfumes of Araby" to "sweeten," not the murder- 
ous hand of a Lady Macbeth, but milady's dainty finger-tips, have 
their ratio7tale in a basis of sanitary law. A writer on this subject 
observes that " the toilet vinegars had their origin in the presump- 
tion of keeping those who carried them from the effects of infec- 
tious disease, doubtless springing out of the story of the four 
thieves' vinegar — reputed freebooters supposed to have plundered 
the sick and dying, protected by the spell of an enchanted prophy- 
lactic composed of rosemary, mint, lavender, calamus, cinnamon, 
cloves, nutmeg, etc. macerated in vinegar." 

Yet the vinaigrette of a lady's boudoir of to-day has its ana- 
logue in the beautiful scent-bottles unearthed among the ruins of 
Pompeii; for the cultivated tastes which still prompt the utility, 
as well as beauty, of flowers are fortified by the tradition of loyal 
centuries, and are, after all, but a tacit tribute to the truth not in- 
aptly stated that " poison and malaria enter the system by neglect- 
ing the warning given it by the nose, that outpost of the animal 
citadel." 

Aromatics owe their virtues chiefly to the volatile oils they con- 
tain, which usually possess the characteristic odor and taste of the 



AROMA TICS. 361 

plants from which they are derived. Locally, they are stimulant 
and irritant. Internally, they stimulate, when taken in moderate 
quantities, the digestive organs in the same manner as vegetable 
bitters, and increase the activity of the circulation reflexly by stim- 
ulating the sensory ends of the vagus distributed to the mucous 
membrane of the stomach. The impression is conveyed to the 
center in the medulla, and from there transmitted to the accelerator 
nerves of the heart. Very large doses depress the heart's action, 
arresting it in diastole. The poisonous action of aromatics is simi- 
lar to that of irritant narcotic poisons. Many of them are quite 
powerful local anesthetics. They first stimulate and then depress 
and exhaust the nervous system. In diseased conditions they are 
used to increase peristalsis, to impart tone to the stomach, and 
to act as antiseptics ; to arrest gastric and intestinal fermentation ; 
to relieve pain wherever they are applied ; and, by increasing the 
circulation in the brain and improving the condition of the gastro- 
intestinal tract, to relieve many of the phenomena of hysteria. 
The chief contraindication for the internal use of these drugs is in 
inflammation of the stomach and bowels. 

The volatile oils and the various preparations of the aromatics 
should be given diluted in some proper vehicle. 

AnTsum—AnIsi— Anise. TJ, S. JP, 

Origin. — The fruit of Pinipijiella Anisum L., a plant indigenous 
in Western Asia and Egypt, and extensively cultivated in Europe. 

Description and Properties. — About \-\ inch (3-6 Mm.) long, 
ovate compressed laterally, grayish, finely pubescent, consisting of 
two mericarps, each with a flat face, and five light-brownish filiform 
ridges, and about fifteen thin oil-tubes, perceptible in transverse sec- 
tion by the aid of the microscope. Anise has an agreeable, aro- 
matic odor, and a sweet, spicy taste. It contains from i-|- to 3 per 
cent, of a volatile oil. It resembles the fruit of the Conium, differ- 
ing from it usually in being longer and more ovate, and having 
another odor and taste. The fruit of the Conium has, moreover, 
but a single smooth mericarp without oil-tubes. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Oleum Anisi— Olei Anlsi— Oil of Anise. TJ. S. JP. 

Origin. — A volatile oil distilled from Anise. 
Description and Properties. — A colorless or pale-yellow, thin 
and strongly refractive liquid, having the characteristic odor of 



362 A TEXT-BOOK OF MA TERIA MEDICA. 

anise, and a sweetish, mildly aromatic taste ; neutral in reaction. 
It contains a substance known as anetliol. 

Oil of anise should be kept in well-stoppered bottles, protected 
from light, and if it has separated into a Hquid and a solid portion, 
it should be completely liquefied by warming before being dis- 
pensed. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Anisi — Aquae Anisi — Anise Water. — Dose, j^-i fiuidounce (8.o-30,a 
Cc). 

Spiritus Anisi — Spiritus Anisi — Spirit of Anise. — Dose, 1-2 fluidrachms 
(4.0-8.0 Cc). 

Oil of anise is contained in the following preparations : 

Spiritus AurSntii Compositus ; Syrupus Sarsaparillse Comp6situs ; Tinc- 
tura Opii Camphorata ; Trochisci Glycyrrhizae et Opii. 

Physiolog-ical Action. — Anise is slightly antiseptic, stimulant, 
and carminative ; Oil of Anise is irritant if applied in full strength to 
mucous membranes, stimulating both the digestive and circulatory 
apparatus, improving the appetite, and slightly strengthening and 
accelerating the heart's action. In very large doses it possesses 
mildly narcotic properties. It is excreted in the urine, sweat, and 
by the bronchial mucous membrane, the secretion from which it 
liquefies. 

Therapeutics. — Anise is employed to relieve flatulence in 
children, as a sedative expectorant, and as a vehicle to flavor 
medicines. 

Cinnamomum—Cinnamomi— Cinnamon. 17. S.I*, 

Orig-in. — There are three official varieties of cinnamon : i , the 
inner bark of the shoots of Cinnainoimiin Zeylanicuin Breyne, a 
tree about 30 feet high (9 M.), found in the forests of Ceylon 
(Ceylon Cinnamon) ; 2, the bark of the shoots of one or more 
undetermined species of Cimiamomuin grown in China (Chinese 
Cinnamon, Cassia Cinnamon) ; 3, the bark of an undetermined 
species of Cinna7noimnii known as Cinnamomum Saigonicum 
(Saigon Cinnamon, Saigon Cassia), from Saigon, the capital of 
French Cochin-China, where it is collected and exported. 

Description and Properties. — Most of the article brought to 
the United States is the Cassia cinnamon. The varieties differ some- 



AROMA TICS. 363 

what in appearance, and are found in the shops as quills of varying 
lengths, about 2^ inch (i Mm.) or more in thickness, yellowish- 
brown in color, externally rough (Cassia), of fragrant odor, a 
sweet, aromatic taste, but less delicate than that of Ceylon cinna- 
mon, which appears in large, closely-rolled quills, composed of 
eight or more layers of bark of the thickness of paper ; pale, 
yellowish-brown, the outer surface smooth, marked with wavy 
lines of bast-bundles ; of a very sweet, fragrant odor, and a warm, 
aromatic, delicate taste. The Saigon cinnamon is found in the 
shops as large quills or broken pieces, -^-.^ to \ inch (2 to 3 Mm.) 
thick ; the outer surface gray or light grayish-brown, with whitish 
patches, more or less rough and warty, transversely ridged and 
longitudinally wrinkled ; the inner surface cinnamon or dark brown, 
granular and slightly striate, with short and granular fracture. It 
has a fragrant odor, and a sweet, warmly aromatic, and somewhat 
astringent taste. 

Constituents. — All the varieties contain volatile oil, tannin, 
mucilage, sugar, starch, a coloring principle, and a peculiar acid. 

The official Oil of Cinnamon is distilled from Cassia Cinnamon. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations {^Cassia Cinnamon). 

Tinctura Cardamomi Composita — Tincturae Cardamomi Compositse — 
Compound Tincture of Cardamom. — Cardamom, 20; Cassia Cinnamon, 20 ; Car- 
away, 10; Cochineal, 5; Glycerin, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose^ 
1-2 fluidrachms (4.0-8.0 Cc). 

Tinctura Catechu CompSsita — Tincturae CStechu Comp6sitae — Compound 
Tincture of Catechu. — Catechu, 100; Cassia Cinnamon, 50; Diluted Alcohol, q. s. 
ad 1000 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Tinctiira Lavandulae Composita — Tinctiirae Lavandulae Compositae — Com- 
pound Tincture of Lavender. — Dose, ^-i fluidrachm (2.0-4.0 Cc). (Formula 
given under Lavender^ 

Official Preparations {Ceylon Cinnamoii). 

Tinctiira Cinnamomi (10 per cent.) — Tinctiirae Cinnamomi — Tincture of 
Cinnamon. — Dose, Yz-i fluidrachms (2.0-8.0 Cc). 

Piilvis AromSticus — Piilveris Arom^tici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2 Gm.). (Formula given under Cardamomwn.^ 

Oleum Cinnamomi— Olei Cinnamomi— Oil of 
Cinnamon. U. S. JP. 

Orig-in. — A volatile oil distilled from Cassia Cinnamon. 
Description and Properties. — A yellowish or brownish liquid, 



364 A TEXT-BOOK OF MATERIA MEDIC A. 

becoming darker and thicker with age and exposure to the air, 
having the characteristic odor of cinnamon, and a sweetish, spicy, 
burning taste. Specific gravity, 1.055 to 1. 065. Soluble in an 
equal volume of alcohol, the solution being slightly acid to litmus- 
paper ; also soluble in an equal volume of glacial acetic acid. It 
should be kept in well-stoppered bottles, in a cool place, protected 
from Hght. 

Constituents. — Oil of cinnamon contains variable quantities of 
hydrocarbon, but consists chiefly of cinnamic aldehyde, and when 
old or exposed to the air for a considerable time cinnamic acid and 
resin are formed. Cinnamic acid crystallizes in* shining, colorless, 
odorless prisms, freely soluble in alcohol, ether, and boiling water. 
Chlorinated lime and hot dilute nitric acid oxidize it into oil of 
bitter almond and benzoic acid. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Cinnamomi (0.2 per cent.) — Aquae Cinnamomi — Cinnamon Water. — 
Dose, \-\ fluidounce (15-30 Cc). 

Spiritus Cinnamomi (10 per cent.) — Spiritus Cinnamomi — Spirit of Cinna- 
mon. — Dose, 5-20 minims (0.3-1.2 Cc). 

Physiological Action. — Cinnamon is an agreeable aromatic 
stimulant, carminative, stomachic, astringent, hemostatic, and anti- 
septic. The oil possesses germicidal properties. 

Therapeutics. — The same as for other aromatics. It is much 
used to impart an agreeable flavor to medicinal compounds and as 
an adjuvant to other members of this group. Preparations of cin- 
namon are supposed to stimulate the uterus and check uterine hem- 
orrhage, and are often employed alone or in combinations with 
more powerful medicines for this purpose. 

Coriandrum—Coriandri— Coriander. 77. >S^. J*. 

Orig-in. — The fruit of Coriandrnm sativum L., an annual herb 
about 2 feet (60.0 Cm.) high, indigenous in China and on the 
north-eastern shore of the Mediterranean. Cultivated in Asia, 
Europe, and America. 

Description and Properties. — Globular, about \ inch (3 Mm.) 
in diameter, slightly pointed at the apex and crowned with the 
calyx-teeth at the base. The two concave mericarps cohere, en- 
closing a lenticular cavity, each furnished on the face with two oil- 
tubes ; odor and taste agreeably fragrant and aromatic. 



AROMA TICS. 2>6^ 

Constituents. — Coriander contains nearly h of i per cent, of 
volatile oil, 13 per cent, of fatty matter, mucilage, and traces of 
tannin. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Oleum Coriandri— Olei Coriandri— Oil of Coriander. 

JJ. S. P. 

Origin. — A volatile oil distilled from Coriander. 

Description and Properties. — A colorless or slightly yellow- 
ish liquid, having the characteristic aromatic odor of coriander, and 
a warm, spicy taste. It is one of the most stable of the volatile 
oils. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

ConfSctio SSnnae (5 per cent.) — Confectionis SSnnae — Confection of Senna. 
— Dose, 1-2 drachms (4.0-8.0 Gm.). (Formula given under Senna.) 

Splritus Juniperi Comp6situs — Spiritus Juniperi CompSsiti — Compound 
Spirit of Juniper. — Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under 
Carufti.) 

Physiological Action and Therapeutics. — The same as those 
of the other volatile oils. Frequently used as a corrective to pur- 
gative medicines. 

FoenTcuIum—Foeniculi— Fennel. 77. S. JP. 

Origin. — The fruit oi Foenictdimi capillaceinn Gilibert, an herba- 
ceous annual or perennial indigenous in Southern Europe and cul- 
tivated in Germany, France, and the United States. 

Description and Properties. — Oblong, nearly cylindrical, 
slightly curved, from -^ to ^ inch (4-12 Mm.) long, brownish or 
greenish-brown, readily separable into the two prominent meri- 
carps, each with five light-brown, obtuse ribs, with four oil-tubes on 
the back and two or four upon the flat face ; odor and taste aro- 
matic, anise-like. 

Constituents. — Fennel contains from 2 to 4 per cent, of volatile 
oil, which is almost identical chemically with that of anise, 12.5 
per cent, of fixed oil, and sugar. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Preparation. 

Infiisum SSnnae Compositum— Infusi SSnnse Comp6siti— Compound In- 
fusion of Senna. — Dose, 1-2 fluidounces (30.0-60.0 Cc). (Formula given under 
Senna.) 



366 A TEXT-BOOK OF MATERIA MEDICA. 

Oleum Foeniculi— Olei Foenlculi— Oil of Fennel. 

V. S. I". 

Orig-in. — A volatile oil distilled from Fennel. 

Description and Properties. — A colorless or pale-yellowish 
liquid, having the characteristic aromatic odor of fennel, and a 
sweetish, mild, and spicy taste. Soluble in an equal volume of 
alcohol. It should be kept in well-stoppered bottles, in a cool 
place, and if it has partly or wholly solidified, it should be com- 
pletely liquefied by warming before being dispensed. 

Constituents. — It has the same constituents as the oil of anise. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua Fceniculi (2 per cent.) — Aquae Fceniculi — Fennel Water. — Dose, \-\ 
fluidounce (8.0-30.0 Cc). 

Ptilvis Glycyrrhlzse Compositus — Ptilveris Glycyrrhizae Compositi— Com- 
pound Liquorice Powder. — Dose,\-2^x2.c\\m'& (2.0-8.0 Gm.), (Formula given under 
Senna. ^ 

Spiritus Juniperi Compositus (0.5 per cent.) — Spiritus Juniperi Compositi — 
Compound Spirit of Juniper. — Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula 
given under Carum.) 

Physiological Action and Therapeutics are the same as those 
of anise. 

Capsicum— Capsici— Capsicum. TJ. S. I*. 

(Cayenne Pepper.) 

Orig-in. — The fruit of Capsicum fastigiatum Blume, a small 
crooked-branched shrub, i to 2 feet (30-60 Cm.) high, indigenous 
in tropical America and Asia, and cultivated in gardens. The 
fruit is an oblong-conical pod from |- to f inch (8-19 Mm.) long, 
of a crimson or yellow color. It encloses two or three cells con- 
taining flat, reniform, yellowish seeds, attached to a thick, central 
placenta. These pods when dried and ground form capsicum, 
which has a peculiar odor and an intensely hot, aromatic taste. 
This ground product is of a bright-red color, fading upon long 
exposure to the Hght. Capsicum of the market usually consists 
of several species ground together, and is often adulterated with 
sawdust and sometimes with red lead. 

Constituents. — Capsicum contains capsaicin, an acrid principle 
found in the greatest amount in the African product ; also a vola- 
tile alkaloid, fixed and volatile oil, and fat acids. 

Dose. — 3-5 grains (0.2-0.3 Gm.). 



AROMA TICS. 367 

Official Preparations. 

Extractum C^psici Fluidum — ExtrScti CSpsici Fluidi — Fluid Extract of 
Capsicum. — Dose, J-to 2 minims (0.03-0.12 Cc). 

EmplSstrum CSpsici — Empiastrum (ace.) CSpsici — Capsicum Plaster. For 
external use. 

Oleoreslna C^psici — Oleoresinae C^psici — Oleoresin of Capsicum. — Dose, 
i-i minim (0.015-0.06 Cc). 

Tinctura CSpsici — Tincturse CSpsici — Tincture of Capsicum. — Dose, 5-20 
minims (0.3-1.2 Co.). 

Physiolog-ical Action. — Externally and Locally. — Capsicum is 
an irritant and rubefacient, producing vesication if kept in contact 
with the skin for a long time. It so irritates the mucous membrane 
of the mouth and nose as to induce sneezing. 

Internally. — Digestive System. — Capsicum is a powerful gastro- 
intestinal stimulant, increasing the flow from the salivary, gastric, 
and intestinal glands. It increases the blood-supply to, and stimu- 
lates the walls of, the stomach, occasioning a sense of heat. It is 
a powerful carminative. Large doses produce great irritation in 
the stomach and bowels. 

Circulatory System. — It is a powerful stimulant to the heart, 
greatly increasing the strength and rapidity of its action. 

Absorption a7id Elimination. — It is chiefly eliminated by the kid- 
neys, increasing the flow of urine. Large doses may produce 
vesical tenesmus, and aphrodisiac effects have sometimes been pro- 
duced. 

Therapeutics. — Externally and Locally. — Owing to its counter- 
irritant action, capsicum is employed to relieve lumbago, torticollis, 
neuralgia, rhemnatic pains, and acute inflammations of the skin or 
mucous membrane. An infusion or the diluted tincture is an 
excellent gargle in relaxed uvida, pharyngitis, and the angina of 
scarlet fever. 

The tinctures of capsicum and cantharides have been used to 
stimulate the scalp in the various forms of alopecia. The tincture 
is frequently used as a domestic remedy for the benefit of chilblains 
and toothache. 

Internally. — Capsicum is a most valuable stomachic in an atonic 
condition of the digestive organs, and a very efficient remedy in 
the irritable and catarrhal conditions of the stomach due to the ex- 
cessive use of alcohol. 

The tincture of capsicum or the powdered drug, added to hot 
water or to hot water and whiskey, makes a valuable and rapid car- 
diac and vascular stimulant. 



368 A TEXT-BOOK OF MATERIA MEDIC A. 

Contraindications. — Capsicum and its preparations should not 
be given in acute inflammatory affections of the gastro-intestinal 
and genito-urinary tracts. 

Administration. — The oleoresin and the powder should be 
given in pills or capsules. The fluid extract and the tincture should 
be administered well diluted with water. 

Piper— PTperis— Pepper. TJ, S. JP. 

(Black Pepper.) 

Origin. — The unripe fruit of Piper nigrum L., a knotted, pointed- 
branched, aromatic, climbing shrub, indigenous in India, and culti- 
vated in many of the East Indian and Philippine and some of the 
West Indian islands. 

Constituents. — Its important constituents are a volatile oil (i to 
2 per cent.) ; a neutral principle, piperiii (6 to 8 per cent.) ; and a 
pungent, soft, dark-green resin, to which the acrid taste and medici- 
nal properties of pepper are due. 

Dose. — 5-20 grains (0.3-1.2 Gm.) 

Official Preparations. 

Oleoresina Piperis — Oleoresinae Piperis — Oleoresin of Pepper. — Dose, \-\ 
grain (0.015-0.06 Gm.). 

Piperinum — Piperini — Piperin. — Origin. — A neutral principle obtained from 
Pepper, as well as from other plants of the natural order Piperacece. 

Description and Properties. — Colorless, or pale-yellowish, shining, prismatic crystals, 
odorless, and almost tasteless when first taken into the mouth, but after a while pro- 
ducing a sharp, biting sensation. Permanent in the air ; almost insoluble in water, but 
soluble in 30 parts of alcohol and in i part of boiling alcohol. It is isomeric with mor- 
phine, and can be decomposed vsxXo pip eric acid 3.nd a liquid alkaloid, piperidine. 

Dose. — i-io grains (0.03-0.6 Gm.). 

Derivative Compound. 

Piperonal — Heliotropin. — Obtained from Piperic Acid by oxidation. It occurs in 
small white crystals, soluble in about 600 parts of cold water, and very readily soluble in 
alcohol and ether. The dose is 10-15 grains (0.6-1.0 Gm.). It has been used as an 
antiseptic and antipyretic. 

Physiological Action and Therapeutics of pepper and its 
preparations are almost identical with those of capsicum. 

Pepper, particularly piperin, possesses antiperiodic and anti- 
septic properties to a greater extent than capsicum. 

Myristica— My rlsticae— Nutmeg-. JJ.H. IP* Macis— 
Macidis— Mace. 77. H. I". 

Origin. — The seed (Myristica) and the membrane, " arillode,'* 



AROMA TICS. 369 

investing the kernel (Mace) oi Myristica fragrans Houttuyn, a tree 
about 30 feet (9 M.) high, found in the Molucca Islands and cul- 
tivated in the East Indies. 



Oleum Myrlsticae— Olei Myristicae— Oil of Nutmeg-. 

V. S. JP. 

Origin. — A volatile oil distilled from Nutmeg. 

Description and Properties. — A thin, colorless or pale-yel- 
lowish Hquid, having the characteristic odor of nutmeg and a 
warm, spicy taste. It becomes darker and thicker by age and ex- 
posure to the air. Soluble in an equal volume of alcohol. It 
should be kept in well-stoppered bottles, in a cool place, protected 
from light. 

Dose. — 1-3 minims (0.06-0.18 Cc). 

Official Preparation, 

Spiritus Myristicae (5 per cent.) — Spiritus Myristicae — Spirit, or Essence, of 
Nutmeg. — Dose, 15-60 minims (1.0-4.0 Cc). 

Physiological Action and Therapeutics are the same as those 
of anise. 



Caryophyllus—Caryophylli— Cloves. TJ. S. JP. 

Origin. — The unexpanded flowers of Eugenia aroviatica (L.) O. 
Kuntze, a hard-wood, shrubby evergreen. It was originally found 
in the Molucca Islands, whence it was introduced and cultivated 
among the East Indian Islands. 

Description and Properties. — The buds are about f inch (15 
Mm.) long, dark-brown, consisting of a subcylindrical, solid and 
glandular calyx-tube, terminated by four teeth and surmounted by 
a globular head, formed by four petals covering numerous curved 
stamens, and one style. A clove resembles a nail (L. claims ; Fr. 
cloii). 

Cloves have a strong aromatic odor and a pungent, spicy taste, 
and when pressed or scratched emit oil. 

Constituents. — Cloves contain about 18 per cent, of a highly 
pungent volatile oil, 17 per cent, of tannin, and small quantities of 
fixed oil, gum, resin, etc. Two crystalline principles have been 
separated : caryopJiyllin^ a white, resinous substance — a stearopten 
— odorless and tasteless ; and eugenin, a substance soluble in boil- 

24 



370 A TEXT-BOOK OF MA TERIA MEDICA. 

ing alcohol and isomeric with eugenol, a constituent of the volatile 
oil. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Official Preparation. 
Tinctura Lavandulae Composita — Tincturae Lavandulae Comp6sitae — Tinc- 
'ture of Lavender. — Dose, \-\ fluidrachm (2.0-4.0 Cc). (Formula given under 
Lavender.^ 

Oleum Caryophylli— Olei Caryophylli— Oil of Cloves. 

V. S. jP. 

Origin. — A volatile oil distilled from Cloves. 

Description and Properties.- — A pale-yellow, thin liquid, be- 
coming darker and thicker by age and exposure to the air, having 
a strongly aromatic odor of cloves and a pungent, spicy taste. Its 
specific gravity is i. 060-1. 067. Soluble in an equal volume of 
alcohol, the solution being sHghtly acid to litmus-paper. 

Constituents. — Oil of cloves consists of a light and a heavy 
oil, the former a hydrocarbon, supposed to be inactive ; the latter 
a phenol-like liquid termed eugenol, a colorless oil, with the odor 
of cloves, a specific gravity of 1.076 to 1.0785, yielding with bases 
crystalline salts. Schenck has demonstrated the presence of sali- 
cylic acid in oil of cloves. 

Dose. — i-io minims (0.06-0.6 Cc). 

Allied Compounds a7td Derivatives. 

Bfenzoyl-eugenol. — Origin. — From Eugenol. 

Description and Properties. — It occurs in neutral, odorless, colorless, acicular crys- 
tals, having a feebly bitter taste ; soluble in hot alcohol, ether, and chloroform, and 
insoluble in water. 

Dose. — Not yet determined. 

Cinnamyl-eugenol. — Origin. — A derivative of Eugenol. 

Description and Properties. — Colorless, odorless, tasteless, lustrous needles, soluble 
in hot alcohol, ether, and chloroform, and insoluble in vi^ater. 

Eugenyl-acStamide. — Origin. — Obtained from Eugenol-acetic-ethyl-ether by 
treating w^ith solution of Ammonia. It occurs as a crystalline powder. 

Physiological Action. — Externally and Locally. — Oil of cloves 
is a counter-irritant, local anesthetic, and germicide. 

Internally, — Its action is essentially the same as that of anise, it 
being a powerful carminative and stimulant. 

Therapeutics. — Externally and Locally. — Oil of cloves is em- 
ployed as a local anesthetic in toothache, earache, and neuralgia^ 
and as a synergist to other counter-irritants, rubefacients, and anti- 



AROMA TICS. 2>7^ 

septics. The eugenol-acetamide is a powerful local anesthetic, 
being analogous to cocaine in its action. 

Internally. — The therapeutics are similar to those of anise. 
The BENZOYL-EUGENOL has been highly recommended by some prac- 
titioners as a valuable remedy in tiiberctilosis. The author has suc- 
cessfully employed the following combination as an antiseptic and 
antifermentative in gastric fermc7itation, to be administered either in 
soft capsules, with olive oil as a vehicle, or in the form of an emul- 
sion : 

R. Olei Caryophylli, 
Olei Cinnamomi, 
Olei Menthae Piperitse, 
Creosoti, aa.XO^y 

M. Sig. — Take at one dose. 

The better way to administer it is in the form of soft capsules, 
each capsule containing the above dose in about 6 minims (0.37 Cc.) 
of olive oil. One or two capsules should be given three times a 
day, after meals. 

Pimenta— Pimentae— Pimenta. JJ, S, P. 

(Allspice.) 

Origin. — The nearly ripe fruit of Pimenta officinalis Lindley, an 
evergreen tree about 30 feet (9 M.) high, indigenous in the West 
Indies, Central America, and the northern part of South America. 

Constituents. — The most important constituent is the volatile 
oil, of which the fruit yields from 3 to 4 per cent. 

Oleum Pimentae— Olei Pimentae— Oil of Allspice. 

V. S. JP. 

Origin.- — A volatile oil distilled from Pimenta. 

Description and Properties. — A colorless or pale-yellow liquid, 
having a strong, aromatic, clove-like odor, and a pungent, spicy 
taste. It becomes darker and thicker with age and exposure. 
With an equal volume of alcohol it forms a clear solution. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiolog'ical Action and Therapeutics are similar to those of 
cloves. 

Oleum Cajuputi— Olei Cajuputi— Oil of Cajuput. 

77. S. JP. 

Origin. — A volatile oil distilled from the leaves of Melaleuca 



372 A TEXT-BOOK OF MATERIA MEDICA. 

leucadendron L., a tree with crooked stem and scattered branches, 
resembling the weeping willow, indigenous in the East Indies. 

Description and Properties. — A Hght, thin, bluish-green, or, 
after rectification, colorless liquid, having a peculiar, agreeable and 
distinctly camphoraceous odor, and an aromatic, bitterish taste. 
Specific gravity, 0.922. With an equal volume of alcohol it affords 
a clear solution, which either has a slightly acid reaction or, in the 
case of the rectified oil, is neutral to litmus-paper. 

Constituents. — The chief constituent is cajuputol, the hydrate 
of the hydrocarbon cajuputene. Cajuputol is identical with euca- 
lyptol. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiolog-ical Action and Therapeutics are identical with those 
of the oil of cloves. 

Cardamomum—Cardamomi— Cardamom. U. S, P* 

Origin. — The fruit of Elettaria repens (Sonnerat) Baillon, a per- 
ennial plant 6 to 10 feet (1.8-3 M-) high. 

Cardamom is indigenous in Hindustan, in the mountainous 
regions of Malabar. 

The same plant furnishes three varieties of cardamoms, known 
in commerce as the shorts, short-longs, and long-longs. 

Description and Properties. — Ovoid or oblong, from f to f 
inch (12 Mm.-2 Cm.) long, obtusely triangular, rounded at the 
base, beaked, longitudinally striate ; of a pale-buff color, three- 
celled, with a thin, leathery, nearly tasteless pericarp and a central 
placenta. The seeds are about \ inch (5 Mm.) long and \ inch (3 
Mm.) broad, reddish-brown, angular, rugose, depressed at the 
hilum, surrounded by a thin membranous arillus. They have an 
agreeable odor and a pungent, aromatic taste. 

The seeds contain 10 per cent, of fixed oil and 4.6 per cent, of a 
volatile oil, besides albuminous matter, gum, starch, etc. The 
volatile oil possesses the odor and taste of the seeds, is colorless 
or yellowish, dextrogyre, contains oxygen, and has a specific 
gravity of 0.93 to 0.94. 

Dose. — 5-15 grains (0.3-1 Gm.). 

Official Preparations. 

Tinctura Cardamomi (10 per cent.) — Tincturae Cardamomi — Tincture of 
Cardamom. — Dose, 1-2 fluidrachms (4.0-8.0 Cc). 

Tmctura Cardamomi CompSsita — Tinctiirae Cardamomi CompSsitae — 



AROMA TICS. 373 

Compound Tincture of Cardamom. — Cardamom, 20; Cinnamon, 20; Caraway, 10; 
Cochineal, 5; Glycerin, 50; Dilute Alcohol, q. s. ad 1000 parts. Dose, I-2 fluid- 
drachms (4.0-8.0 Cc). 

Piilvis Aromaticus — Piilveris Aromatic! — Aromatic Powder. — Ceylon Cinna- 
mon, 35; Ginger, 35; Cardamon, 15; Nutmeg, 15. Dose, 10-30 grains (0.6- 
2.0 Gm.). 

There is also a fluid extract made from this powder. Dose, 10-30 minims (0.6- 
2.0 Cc). 

Antagonists and Incompatibles. — Free acids are incompatible 
with the compound tincture of cardamom, separating insoluble car- 
minic acid in it. 

Physiolog'ical Action. — In this respect Cardamom conforms to 
the general character of the Aromatic Group. 

Therapeutics. — Essentially the same as for other members of 
this group. Cardamom is used principally as an adjuvant to other 
aromatics, stimulants, stomachics, and carminatives. 

Zingiber— Zingiberis—Gingrer. TJ. S, jP, 

Origin. — The rhizome of Zingiber officinale Roscoe, a perennial 
herb indigenous in tropical Asia and now cultivated in most tropi- 
cal countries. 

Description and Properties. — A thick, flattish rhizome from i 
to 4 inches (25 to 100 Mm.) long, with club-shaped lobes on one 
side ; deprived of the corky layer, pale, buff-colored, striate, 
breaking with a mealy, rather fibrous fracture, showing numerous 
small, scattered resin-cells and fibro-vascular bundles, the latter 
enclosed by a nucleus sheath. Agreeably aromatic, and of a warm, 
pungent taste. 

Ginger contains from f to 2 per cent, of a pale-yellow, volatile 
oil, to which the ginger owes its aromatic properties ; also a soft 
resin, giving to the drug its hot, pungent taste. The proportion 
of resin present varies with the different varieties of ginger, that 
from the East Indies yielding about 8 per cent, while the Jamaica 
product yields only about 5 per cent. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Preparations. 

Extractum Zingiberis Fluidum— Extract! Zingiberis Fluid! — Fluid Ex- 
tract of Ginger. — Dose, 10-30 minims (0.6-2.0 Cc). 

Oleoresina Zingiberis — Oleoresinae Zingiberis — Oleoresin of Ginger. — 
Dose, 1-3 grains (0.06-0.18 Gm.). 

Ptilvis Aromaticus— Piilveris AromStici — Aromatic Powder. — Dose, 10-30 
grains (0.6-2.0 Gm.). (Formula given under Cardamomum.) 



374 A TEXT-BOOK OF MATERIA MEDICA. 

Ptilvis Rhei Compdsitus — Ptilveris Rhei Compositi — Compound Powder 
of Rhubarb. — Rhubarb, 25; Magnesia, 65; Ginger, 10 parts. Dose, y^-i drachm 
(2.0-4.0 Gm.). 

Syrupus Zingiberis — Syrupi Zingiberis — Syrup of Ginger. — Dose, j/^-2 
drachms (2.0-8.0 Cc). 

Tinctura Zingiberis — Tinctiirae Zingiberis — Tincture of Ginger. — Dose, 1-2 
fluidrachms (4.0-8.0 Cc). 

Trochisci Zingiberis — Trochiscos (ace.) Zingiberis — Troches of Ginger. — 
Dose, use freely as required. 

Physiological Action and Therapeutics are almost identical 
with those of other aromatics. Ginger is especially valuable as a 
stomachic and carminative, to stimulate the stomach, improve the 
appetite, and relieve flatulency and colic. It is a safe and efficient 
domestic remedy for the relief of simple diarrhea. It is also much 
used as a corrective to modify the taste and action of other 
medicines. 

Calamus— Calami— Calamus. TJ. S, -P. 

(Sweet Flag.) 

Origin. — The rhizome of Acorus Calamus L., a plant indige- 
nous in North America, Europe, and Western Asia, growing in 
swamps and along the shores of streams and ponds. 

Description and Properties. — Calamus is found in subcylin- 
drical sections of various lengths, about I inch (2 Cm.) broad, 
externally reddish-brown, internally whitish, of a spongy texture, 
breaking with a short, corky fracture, showing numerous oil-cells 
and scattered wood-bundles. It has a strong aromatic, fragrant 
odor, and a warm, peculiar, bitterish taste. Calamus contains from 
I to 2 per cent, of volatile oil possessing the odor and taste of cal- 
amus, a glucosid (acorin) in the form of a bitter, yellow syrupy 
liquid, besides calamine, choline, resin, starch, and mucilage. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparation. 

Extractum Caiami Fluidum— ExtrScti Calami Fluidi— Fluid Extract of 
Calamus. — Dose, 15-60 minims (1.0-4.0 Cc). 

Physiological Action and Therapeutics. — The action of cala- 
mus is similar to that of anise, but it is more tonic than the latter. 
Large doses of the volatile oil produce tetanic convulsions. 

It is used for the same purposes as anise, but probably possesses 
more stomachic and carminative properties. 



AROMA TICS. 375 

Oleum Gaultheriae— Olei Gaultheriae— Oil of Winter- 
green. U. S, jP. 

Origin. — A volatile oil distilled from the leaves of Gaultheria 
procumbe?is L., a small evergreen plant indigenous in the northern 
hemisphere and bearing a scarlet, fleshy, berry-like fruit. 

Description and Properties. — The volatile oil is a colorless or 
yellow, or occasionally reddish, Hquid, having a characteristic, 
strongly aromatic odor, and a sweetish, warm, and aromatic taste. 
Specific gravity, 1.175 to 1.185. 

It consists almost entirely of methyl salicylate. It should be 
kept in well-stoppered bottles, protected from light. 

Dose. — 2-10 minims (0.12-0.6 Cc). 

Official Preparation. 

Spiritus Gaultheriae — Spiritus Gaultheriae — Spirit of Gaultheria (Essence 
OF Wintergreen). — Dose, 1-2 fluidrachms (4.0-8.0 Cc). 

Physiological Action. — Externally and Locally. — Oil of winter- 
green is a stimulant and a powerful antiseptic. 

Internally. — Its action is identical with that of salicylic acid and 
its salts, but it does not depress the heart like the latter drugs. 

Therapeutics. — Externally and Locally. — Used for the same 
purposes as oil of cloves and other aromatic oils. 

Internally. — Used for the same purposes as salicylic acid. 

Oleum Lavandulae F15rum— Olei Lavandulae Florum 
— Oil of Lavender Flowers. V, S. JP. 

Origin. — A volatile oil distilled from fresh flowers of Lavandida 
officinalis Chaix. Lavender is native to Southern Europe and 
cultivated in gardens. 

Description and Properties. — A colorless or yellowish liquid, 
having the fragrant odor of lavender flowers and a pungent and 
bitterish taste. Soluble in all proportions of alcohol. It should 
be kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Spiritus Lavandulae (5 percent.) — Spiritus Lavandulae — Spirit of Lavender. 
— Dose, yi-i fluidrachm (2.0-4.0 Cc). 

Tinctura Lavandulae Composita— Tincturae Lavandulae CompSsitae— Com- 



Zl(i A TEXT-BOOK OF MATERIA MEDICA. 

pound Tincture of Lavender. — Oil of Lavender, 8; Oil of Rosemary, 2; Cassia 
Cinnamon, 20; Cloves, 5; Nutmeg, 10; Red Saunders, 10; Alcohol, 0.7; Water, 250; 
Diluted Alcohol, q. s. ad 1000 parts. Dose, ^-i fluidrachm (2.0-4.0 Cc). Com- 
pound Tincture of Lavender is an ingredient of Liquor Potassii Arsenitis. 

Physiolog-ical Action and Therapeutics are the same as those 
of other volatile oils mentioned in this group. 



Mentha Piperita— Menthae Piperitae— Peppermint. 

77. H. P. 

Origin. — The leaves and tops of Mentha piperita Smith, a 
perennial plant found in damp places in England and other Euro- 
pean countries and in North America. 

Peppermint contains about i per cent, of a volatile oil — its most 
important constituent. 

Official Preparation. 

Spiritus MSnthae Piperitae (10 per cent.) — Spiritus MSnthae Piperitae — Spirit, 
or Essence, of Peppermint. — Dose, 5-60 minims (0.3-0.4 Cc). 
Spirit of Peppermint is an ingredient of Mistura Rhei et Sodae. 

Oleum Menthae Piperitae— Oiei Menthae Piperitae— 
Oil of Peppermint. V. S. P. 

Origin. — A volatile oil distilled from Peppermint. 

Description and Properties. — A colorless or yellowish or 
greenish-yellow liquid, becoming darker and thicker by age and 
exposure to the air, having the characteristic strong odor of pep- 
permint, and a strongly aromatic, pungent taste, followed by a 
sensation of cold upon inhalation. It forms a clear solution with 
an equal volume of alcohol, becoming turbid when further diluted, 
and is soluble in all proportions in carbon disulphide and in glacial 
acetic acid. 

When exposed to a freezing temperature the oil becomes thick 
and cloudy, and separates crystals of menthol, to which it owes its 
peculiar odor. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Official Preparations. 

Aqua MSnthae Piperitae [0.1 per cent.) — Aquae MSnthae Piperitae — Pepper- 
mint Water. — Dose, j^-i flmdounce (15.0-30.0 Cc). 

Trochisci MSnthae Piperitae (.01 Cc. \\\ each)— Trochiscos (ace.) M6nthae 
Piperitae — Troches of Peppermint. — Dose, freely as desired. 



AROMA TICS. 2>17 

Menthol— Menthol— Menthol. U. S. I*. 

Orig-in. — A stearopten obtained from the official Oil of Pepper- 
mint or from Japanese or Chinese Oil of Peppermint. 

Description and Properties. — Colorless, acicular or prismatic 
crystals, having a strong and pure odor of peppermint, and a 
warm, aromatic taste, followed by a sensation of cold when air is 
inhaled. Menthol is but slightly soluble in water, but imparts to 
the latter its odor and taste. It is freely soluble in alcohol, ether, 
chloroform, carbon disulphide, and glacial acetic acid. 

Dose. — J-2 grains (0.03-0.12 Gm.). 

Allied Co7npounds. 

Benzoate of Menthol ; Chloral Menthol. — These combinations are quite active 
local anesthetics and analgesics. 

Physiolog'ical Action and Therapeutics. — Externally and Lo- 
cally. — Menthol is an antiseptic, antipruritic, analgesic, and anes- 
thetic, as well as a germicide. It is used for the same purposes as 
oil of cloves. It is used extensively in headache, being rubbed 
on the forehead. Owing to its analgesic properties, it is used in 
the form of an ointment in various strengths for painful hemor- 
rhoids, burns, boils, and superficial inflammations. 

The OIL OF PEPPERMINT, or MENTHOL, is an ingredient of many 
sprays and lotions for the treatment of diseases of the ear, nose, and 
throat. 

As an antipruritic menthol is a valuable remedy to relieve the 
itching of eczema, pruritus, urticaria, etc. It should be dissolved 
in oil for this purpose^in severe cases 50 grains to i ounce (3.2 
Gm. to 30.0 Cc). 

Internally. — The uses of oil of peppermint are similar to 
those of other aromatic oils, it being a valuable carminative, stimu- 
lant, antifermentative, and antispasmodic. In small doses menthol 
has been given to allay nausea and vomiting and to relieve the 
pain of gastralgia. 

Mentha Viridis— Menthae Viridis— Spearmint. 

77. H. P. 

This is one of the mints, found in the same localities as 
peppermint, and containing, Hke the latter drug, a volatile oil 
forming its active constituent. It possesses milder properties than 
peppermint, although similar to it in its action and uses. To some 



378 A TEXT-BOOK OF MA TERIA MEDICA. 

people it has a more agreeable taste than peppermint, and in 
infantile cases it is usually preferred. 

Official Preparations. 

Aqua MSnthae Viridis — Aquae MSnthae Viridis — Spearmint Water. 
Spiritus MSnthae Viridis — Spiritus MSnthae Viridis — Spirit, or Essence, of 
Spearmint. 

The dose of the oil of spearmint and of the above preparations is the same as for 
the corresponding oil and preparations of peppermint. 

Thymol— Thymol-Thymol. U. S. I". 

Origin. — A phenol or stearopten occurring in, and obtained by, 
freezing or distilling the volatile oils of Thymus vulgaris^ Thymus 
nionarda, and Carmn ajowaii. 

Description and Properties. — Large, colorless, translucent 
crystals of the hexagonal system, having an aromatic, thyme-like 
odor, and a pungent aromatic taste, with a very slight caustic effect, 
upon the lips. Its specific gravity as a solid is 1.069, but when 
liquefied by fusion it is Hghter than water. It is soluble in about 
1200 parts of water and in less than its own weight of alcohol, 
ether, or chloroform ; also readily soluble in carbon disulphide, 
glacial acetic acid, and in fixed or volatile oils. When triturated 
with about equal quantities of camphor, menthol, or chloral, it 
Hquefies. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Allied and Derivative Compound. 

ThymScetin, a derivative of thymol, prepared after the manner of phenacetin, and 
holding the same relation to thymol as phenacetin does to phenol (carbolic acid). It is 
a white, ciystalline powder, sparingly soluble in water. Dose, 3-10 grains (0.2-0.6 
Gm.). 

Physiological Action and Therapeutics are similar to those of phenacetin, thymace- 
tin possessing marked analgesic and hypnotic properties. 

Physiolog'ical Action. — Thymol is a powerful antiseptic, being 
ten times less poisonous .than carbolic acid, yet as an antiseptic far 
superior to it. While stimulant, it is not irritant or corrosive. It 
is also a deodorant, disinfectant, parasiticide, and local anesthetic, 
as well as an antipruritic, antipyretic, and antifermentative. 

Absorption and Elimination. — It is eliminated chiefly by the 
lungs and kidneys, producing some irritation at the points of 
ehmination. The urine is increased in quantity, often assuming a 
dark greenish hue. 



AROMA TICS. 379 

Untoward Action. — The following symptoms have been pro- 
duced by the administration of large doses : burning sensation in 
the mouth and stomach, persisting in some instances for days, 
accompanied by pain and tenderness under pressure. According 
to Balz, " perspiration is sometimes observed, and occasionally a 
transient buzzing in the ears and deafness." 

Poisoning. — In addition to untoward manifestations, there may 
be nausea and vomiting, profuse sweating, great reduction of tem- 
perature, dizziness, violent dehrium, and collapse. 

Therapeutics. — Externally and Locally. — The applications of 
thymol in surgery are identical with those of carbohc acid. Among 
surgeons who recommend and use it is Mr. Spencer Wells, who 
employs it in a solution of i : looo for spray, irrigation, sponges, 
instruments, and all other antiseptic purposes. 

Crocker in 1878 introduced it as an efficient remedy in certain 
skin diseases. It probably owes its value in these cases to its anti- 
pruritic and antiparasitic properties. 

It is also extensively used in diseases of the nose, throat, and 
ear, and in certain disorders of the genito-wdnary tract. Thymol 
is also administered by inhalation in certain broncho-ptdnionary 
disorders. 

Internally. — Thymol is used for the same purposes as other 
antiseptics, such as carbolic acid, resorcin, beta-naphtol, etc. 

Martini highly recommends it as an intestinal antiseptic in the 
treatment of diarrhea, dysentery, and typhoid fever. 

BulfaHni has employed it with some success in limiting fermen- 
tation during a proteid diet in the treatment of diabetes. It has 
also been favorably recommended in phthisis, vesical catarrh, sto- 
matitis, and diphtheria. 

Administration. — It may be applied externally in solution 
(i : 1000), as an ointment (i-io per cent), or in the form of thymol 
gauze as a surgical dressing (i per cent, of thymol). 

For internal use it should be given in pills or capsules. 



Carum—Cari— Caraway. TJ, S. JP. 

Origin. — The fruit of Cariun Carvi L., a biennial plant native 
to Central and Western Asia. It is cultivated in Europe and in the 
United States. 

Description and Properties. — Oblong, laterally compressed, 
about -g- to I" inch (4-5 Mm.) in length, tapering somewhat at the 



38o A TEXT-BOOK OF MATERIA MEDICA, 

ends, brown, with five yellowish, filiform ribs, and six oil-tubes. 
Caraway has an agreeable odor and a sweetish, spicy taste. 

Constituents. — It contains from 5 to 7 per cent, of a volatile 
oil. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

Tinctura Cardamomi Composita (10 per cent.) — Tincturse Cardamomi 
Compositae — Compound Tincture of Cardamom. — Dose^ 1-2 fluidrachms (4.0- 
8.0 Cc). (Formula given under Cardamomum.) 



Oleum Cari— Olei Cari— Oil of Caraway. U. S. JR. 

Origin. — A volatile oil distilled from Caraway. 

Description and Properties. — A colorless or pale-yellow, thin 
liquid, having the characteristic aromatic odor of caraway and a 
mild, spicy taste. Soluble in an equal volume of alcohol, this 
solution being neutral to litmus-paper. 

By fractional distillation the oil may be separated into two 
portions : a light hydrocarbon with but little odor and taste, 
carvene, and a heavy oil having an agreeable caraway odor, carvol, 
and isomeric with menthol, myristicol, and thymol. 

Dose. — I -10 minims (0.6-0.66 Cc). 

Official Preparation. 

Spiritus Juniperi Comp6situs (0.05 per cent.) — Spiritus Juniperi Comp6siti — 
Compound Spirit of Juniper. — Oil of Juniper, 4 ; Oil of Caraway, \ ; Oil of Fennel, 
y^ ; Alcohol, 0.7; Water, q. s. ad 1000 parts. Dose, 2-4 fluidrachms (8.0-15.0 Cc). 

Physiolog-ical Action and Therapeutics. — The same as those 
of the other aromatic oils. 



CLASS II -SYMPTOM MEDICINES. 



GROUP L— ANTISPASMODICS. 

Antispasmodics are remedies used to allay spasm and quiet 
nervous excitement or improve unfavorable conditions of the 
mind, as in cases of convulsions, hysteria, melanchoHa, hypo- 
chondriasis, etc. They act as stimulants to the brain and higher 
nervous centers, and as depressants of the lower centers, diminish- 
ing muscular activity and, partly through their action upon the 
higher nervous centers, increasing the co-ordinating power. They 
are to a considerable degree cardiac stimulants, diaphoretics, ex- 
pectorants, and antiseptics. 

Asafdetida— Asafoetidae— Asaf etida. TI. S. P. 

Origin. — A gum resin obtained from the root of Ferula foetida 
(Bunge) Regel, a large perennial herb found in Turkestan, Western 
Thibet, and Western Afghanistan. 

Description and Properties. — Irregular masses composed of 
whitish tears imbedded in a yellowish- or brownish-gray, sticky 
mass. The tears when hard break with a conchoidal fracture, 
showing a milk-white color, which changes, on exposure, to pink, 
and finally to brown. The drug has a persistent alliaceous odor 
and a bitter, alliaceous, acrid taste. When triturated with water it 
yields a milk-white emulsion, which becomes yellow upon the addi- 
tion of ammonia water. It is partly soluble in ether, and at least 
60 per cent, of it should dissolve in alcohol. 

Dose. — 5-8 grains (0.3-0.5 Gm.). 

Official Preparations. 

Emiilsum Asafoetidae — Emtilsi Asafoetidae — Emulsion of Asafetida. —Dose, 
2-4 fluidrachms (7.39-15 Cc). 

Pilulae Aloes et Asafoetidae — Pilulas (ace.) Aloes et Asafoetidae. — Pills of 
Aloes and Asafetida. — Dose, 2 to 5 pills. 

Pilulae Asafoetidae — PUulas (ace.) Asafoetidae — Pills of Asafetida. — Dose, 
2 to 5 pills. 

Tinctura Asafoetidae — Tincturae Asafoetidae — Tincture of Asafetida (20 
per cent.). — Dose, 10-40 minims (0.6-2.5 Cc.). 

381 



382 A TEXT-BOOK OF MATERIA MEDIC A. 

Ammonlacum—Ammonlaci— Ammoniac. 77. >S^. jP. 

Orig-in. — A gum resin obtained from Dorema Ammoniacmn 
Don, a plant 6 or 7 feet (2 M.) high, found in the deserts and 
barren regions of Persia and Tartary. 

Description and Properties. — Roundish tears, JL-J inch (1.5- 
12 Mm.) in diameter; externally pale yellowish-brown, internally 
milk-white ; brittle when cold, and breaking with a flat, conchoidal, 
and waxy fracture ; or the tears are superficially united into irreg- 
ular masses without any intervening dark-colored substance. It 
has a peculiar odor and a bitter, acrid, and nauseous taste. When 
triturated with water it readily yields a milk-white emulsion. It 
contains from 1.8 to 4 per cent, of volatile oil, 70 to 72 per cent, 
of resin, and 18 to 22 per cent, of gum. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Prepm^ations. 

Empiastrum Ammonlaci cum Hydrargyro — Empiastra Ammoniaci cum 
HydrSrgyro — Ammoniac Plaster with Mercury, — For external use. 

Emiilsum Ammoniaci — Emtilsi Ammoniaci — Emulsion of Ammoniac 

(4 per cent.). — Dose, Yz-l fluidounce (15 to 30 Cc). 

Camphora—Camphorae— Camphor. 77. H. JP. 

Origin. — A stearopten (of the nature of a ketone) obtained 
from Cimiarnoimim campJiora L., and purified by sublimation. The 
camphor laurel is a handsome tree 25 to 30 feet (7.5-9 M.) high, 
indigenous in Eastern and Southeastern Asia, and cultivated in 
Italy as an ornamental tree. 

Description and Properties. — White, translucent masses, of a 
tough consistence and crystalline structure, readily pulverizable in 
the presence of a little alcohol, ether, or chloroform ; having a 
penetrating, characteristic odor and a pungently aromatic taste. 
Very sparingly soluble in water, but readily soluble in alcohol, 
ether, chloroform, carbon disulphide, benzin, and in fixed and vola- 
tile oils. 

When camphor is triturated in about molecular proportions 
with menthol, thymol, phenol, or chloral hydrate, liquefaction 
ensues. It melts at 175° C. (347" F.), boils at 204° C. (399.2° F.), 
and is inflammable, burning with a luminous, smoky flame. On 
exposure to the air it evaporates more or less rapidly at ordinary 
temperatures, and when moderately heated it sublimes without 
leaving a residue. 



ANTISPASMODICS. 383 

From camphor may be obtained a number of interesting com- 
pounds, such as cainpJwric acid, cyniol, etc. The drug should be 
kept in well-closed vessels, in a cool place. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Official Preparations. 

Aqua Camphorae — Aquae Camphorse — Camphor Water (0.8 per cent.). — 
Dose, \-2 fluidounces (15-30 Cc). 

LinimSntum Camphorae — LinimSnti Camphorae — Camphor Liniment. — 
Camphor, 20; Cotton Seed Oil, 80 parts. For external use. 

LinimSntum Saponis — LinimSnti Saponis — Soap Liniment (4.5 percent.). — 
For external use. 

Spiritus Camphorae — Spiritus Camphorae — Spirit of Camphor (10 per cent.). 
— Dose, 5-40 minims (0.3-2.6 Cc). 

Tinctura Opii Camphorata — Tincturae Opii Camphoratae — Camphorated 
Tincture of Opium (0.4 per cent.). — Dose, 1-4 fluidrachms (4-15 Cc). 

Camphora Monobromata— Camphorae Monobro- 
matse— Monobromated Camphor. V. S. JR. 

Origin. — Prepared by heating Camphor and Bromine, dissolving 
in Benzin, and crystallizing from hot Alcohol. 

Description and Properties. — Colorless, prismatic needles or 
scales, of a mild, camphoraceous odor and taste, permanent in the 
air, unaffected by light, and neutral to litmus-paper. Almost in- 
soluble in water; freely soluble in alcohol, ether, chloroform, hot 
benzin, and fixed and volatile oils ; slightly soluble in glycerin. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Acidum CamphSricum — Acidi CamphSrici — Camphoric Acid. — Origin. — 
Obtained by the oxidation of Camphor through the action of Nitric Acid. 

Description and Properties. — White, acicular crystals, odorless, and of a weak, acid, 
and slightly astringent taste. Soluble in hot water, alcohol, ether, and fatty oils ; almost 
insoluble in cold water. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Valeriana— Valerianae— Valerian. TJ, S. J*. 

Origin. — The rhizome and roots of Valeriana officinalis L., an 
herbaceous perennial 2 to 4 feet (0.6-1.2 M.) high, a native of 
Europe, and cultivated to some extent in New England and New 
York. 

Description and Properties. — The rhizome varies in length be- 
tween \ and i^ inches (1-3 Cm.), and has nearly an equal diameter, 
thick, upright, subglobular or obconical, truncate at both ends, 
brown or yellowish-brown, internally whitish or pale-brownish, 



384 A TEXT-BOOK OF MA TERIA MEDICA. 

with a narrow circle of white wood under the thin bark. Roots 
numerous, slender, brittle, brown, with a thick bark and slender,, 
ligneous cord. Odor peculiar, becoming stronger and unpleasant 
on keeping; taste camphoraceous and somewhat bitter. 

Valerian contains valerianic and other acids and a volatile oil- 
Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations, 

Extractum Valerianae Fluidum — ExtrScti Valerianae Fluidi — Fluid Ex- 
tract of Valerian. — Dose, 15-60 minims (1.0-4,0 Cc). 

Tinctiira Valerianae — Tincturae Valerianae — Tincture of Valerian (20 per 
cent.). — Dose, 1-2 fluidrachms (4-8 Cc). 

Tinctiira Valerianae Ammoniata — Tinctiirae Valerianae Ammoniatae — Am- 
moniated Tincture of Valerian (20 per cent.). — Dose, 30-60 minims (2.0-4.0 Cc,). 

Ammonii Valerianas— Ammonii Valerianatis— Am- 
monium Valerianate. TJ. S. JP. 

Origin. — Obtained by saturating Valerianic Acid with Gaseous 
Ammonia and crystallizing. 

Description and Properties. — Colorless or white quadrangular 
plates, emitting the odor of valerianic acid ; of a sharp and sweet- 
ish taste ; deliquescent in moist air. Very soluble in water and in 
alcohol. Ammonium valerianate should be kept in well-stoppered 
bottles. 

Dose. — 2-10 grains (0.12-0.6 Gm.). 

Ferri Valerianas— Ferri Valerianatis— Ferric 
Valerianate. U. S. JP. 

Origin. — Prepared by mixing solutions of Ferric Sulphate and 
Sodium Valerianate and washing the precipitate formed. 

Description and Properties. — A dark brick-red amorphous 
powder of somewhat varying chemical composition, having the 
odor of valerianic acid and a mildly styptic taste ; permanent in 
dry air. Insoluble in cold water, but readily soluble in alcohol. 
Ferric valerianate should be kept in small, well-stoppered bottles,, 
in a cool and dark place. 

Dose. — 1-3 grains (0.6-0.2 Gm.). 

ZTnci Valerianas— ZTnci Valerianatis— Zinc Vale- 
rianate. V. S. P. 

Origin. — Obtained by evaporating hot solutions of Zinc Sul- 



ANTISPASMODICS. Z^^ 

phate and Sodium Valerianate, the zinc valerianate crystallizing 
out. 

Description and Properties. — White, pearly scales, having the 
odor of valerianic acid and a sweetish, astringent, and metallic 
taste. On exposure to air it slowly loses valerianic acid. Soluble in 
about lOO parts of water and in 40 parts of alcohol. It should be 
kept in small, well-stoppered bottles. 

Dose. — J-3 grains (0.03-0.2 Gm.). 



Antagonists and Incompatibles. — The actions of asafetida, 
AMMONIAC, and camphor are opposed by arterial sedatives, acids, 
and neutral salts, while quinine, digitalis, and ergot antagonize the 
action of valerian. 

Water and aqueous solutions precipitate camphor from its alco- 
hoHc solution. 

Synergists. — The antispasmodics are synergistic to' each other. 
They are also aided in their action by the aromatics and many of 
the gum resins and balsams, alcohol, ether, etc. 

These remedies are so nearly alike in their action that their 
physiological effects will here be considered as a whole, mention 
being made of any marked difference in their individual action 
should it exist. 

Physiological Action. — Exterjially and Locally. — The only 
member of this group having any special local action is camphor. 
This drug has an anesthetic effect upon the unbroken skin, but in 
a concentrated state is very irritating to mucous membranes, and 
may even produce inflammation and sloughing. Camphor is also 
a powerful parasiticide. 

Digestive System. — In medicinal doses antispasmodics stimulate 
the digestion and augment the secretions from the gastro-intestinal 
tract. They also stimulate peristalsis, and are active carminatives 
and calmatives to the digestive tract. Asafetida is the most laxa- 
tive of all. 

Large doses of any antispasmodic cause nausea, vomiting, and 
purging, camphor being the most irritant, and in toxic doses acting 
as an irritant poison. 

Circulatory System. — In medicinal doses the antispasmodics in- 
crease the force of the heart and elevate arterial tension. 

Asafetida exerts the greatest influence on menstruation, while 
camphor has the most marked effect upon the general circulation. 

Nej'vous System. — It is probably upon the nervous system that 

25 



3S6 A TEXT-BOOK OF MATERIA MEDIC A. 

these drugs exert their most potent action. They are all stimu- 
lants to some portion of the cerebrum. Their precise influence 
upon the brain is, however, unknown, and in order to form a better 
conception of the action of these drugs some explanation of the 
function of the brain is necessary. 

The cerebrum consists of a complex mechanism, each localized 
area having a definite physiological function, the relations of the 
several areas differing one from another, some being equal and 
others subordinate. These areas probably are — i. Perception areas 
— five ; 2. Judgment areas ; 3. Emotion areas ; 4. Motor areas ; 
5. Inhibitory areas. These areas are all connected by commissural 
fibers. 

The emotion and motor areas are controlled by the functional 
influence of the areas of inhibition. Sometimes disturbing influ- 
ences modify this adjustment, so that the lower areas act inde- 
pendently. The perturbation may be due either to deficient power 
of inhibition, to unusual activity of the lower areas, or to lack of 
co-ordination in the connecting fibers by which the unimpeded areas 
are held in subjection. Even a slight loss of command occasions 
in the subject an irritability readily aroused, together with annoy- 
ance from trivial causes which under normal conditions would be 
inconsequential. The mental derangement accompanying these 
phenomena we call nervousness, and when the symptoms become 
still further aggravated the mental disturbance known as hysteria 
results. 

Again, the emotion and cerebral motor areas may become so 
far freed from restraint that even violent hysterical symptoms ensue, 
including convulsions or coma. Obviously, therefore, the only 
remedy for the malady is to restore the equilibrium between the 
inhibitory and lower areas. 

This may be effected either by stimulation of the debilitated 
areas of inhibition, by depression of the over-active lower areas, or 
by supplying a possible deficiency in the conductive force of the 
fibers. The first of these desiderata may be attained by improving 
the circulation and affording stronger nutriment. By dilating the 
arterioles small doses of alcohol and ether accomplish this object, 
and may act favorably in an attack of hysteria. Alcohol, however, 
in large doses exerts a deleterious influence by causing exceeding 
depression of the central nervous system, resulting in incoherence. 
Arsenic, quinine, cod-liver oil, and iron by their tonic effects may, 
under continued dosage, abort access of hysteria. 



ANTISPASMODICS. 387 

Other remedial agents which tend to act directly upon the cell- 
ular structure of the inhibitory areas, and thereby invigorate them, 
are the drugs under consideration — the antispasmodics. By stim- 
ulation of the inhibitory centers they may allay the spasms of 
hysteria. 

The morbid activity of the lower areas may be ameliorated by 
depressant remedies, among which morphine and the bromides may 
prove particularly beneficial. 

The antispasmodics, it will be seen, appear to exert a calmative 
influence upon certain nerve-centers, allaying nervous excitement 
and muscular spasm. They produce a gentle, exhilarating effect 
upon the brain, and diffuse a feeling of warmth in the system. It 
is claimed that they also possess mildly aphrodisiac properties. 
Excessive doses, on the other hand, may occasion delirium, even 
merging in maniacal excitement, this being particularly true of 
CAMPHOR, toxic doses of which drug, in the monobromated form, 
cause muscular weakness, passing into paralysis, followed by stupor 
and collapse. Valerian may occasion formication of the hands 
and feet and a condition of melanchoHa. 

Respiratory System. — The antispasmodics are all respiratory 
stimulants and stimulant expectorants. Large doses of mono- 
bromated CAMPHOR depress respiration. 

Absorption and Elimination. — These drugs are readily absorbed 
from the stomach or rectum, and are eliminated by the intestinal 
tract, kidneys, lungs, skin, and mucous membranes generally, stim- 
ulating the glands in these structures, and, in the case of asafetida 
and valerian, imparting the characteristic odor of these drugs to 
the excretions. 

Temperature. — Unaffected except by monobromated camphor, 
which in large doses acts as a depressant. 

Uterus. — The menstrual flow and sexual appetite are increased 
at first ; continued dosage, however, has a depressing effect upon 
the generative functions, camphor perhaps being the most active 
in large doses. 

It is said that the sexual passion of cats is extraordinarily 
excited by valerian, probably because of its odor. 

Untoward Action. — Camphor may occasion mental confusion, 
headache, vertigo, dryness of the mouth and thirst, flushing of the 
face, clammy perspiration, disturbances of digestion, and strangury. 
Musk produces similar untoward manifestations, with a sense of 
pressure in the eye-sockets and marked sexual excitement. The 



388 A TEXT-BOOK OF MATERIA MEDICA. 

symptoms caused by valerian are very much the same, although,, 
as in the untoward action of asafetida, there is more disturbance 
of the gastro-intestinal tract, such as nausea, borborygmi, diarrhea^ 
and coHcky pains. Barbier noted visual hallucinations in a person 
treated with valerian. 

Poisoning. — The symptoms of poisoning resemble the untoward 
action, save that the effects may be more marked, with greater 
irritation of the intestinal tract and more pronounced cerebral 
disturbance. 

Treatment of Poisoning, — Coffee and the arterial sedatives an- 
tagonize the action of camphor. The patient should be treated 
symptomatically ; emetics or the stomach-pump should be employed, 
and measures taken to favor elimination. Excessive nervous mani- 
festations may be controlled by opium or the bromides. 

Therapeutics. — Externally and Locally. — The only member of 
the present group used locally is camphor, its anesthetic and anti- 
pruritic properties rendering it of great value in the treatment of 
diseases of the skin. ''Anderson's powder," composed of pulver- 
ized camphor, starch, and zinc oxide, is a very soothing and 
efficient dusting powder in erythema, erythematous eczema, and urti- 
caria. " Camphor-ice " and ointments of camphor, alone or com- 
bined with salicylic acid, are used for " chapped hands',' ulcers, etc. 

Various inhalants and powders containing camphor have been 
successfully employed in the treatment of ozena, acute coryza, and 
laryngitis. Suppositories of camphor afford great relief in cases 
of chordee, while the camphor liniment is a household remedy for 
sprains, bruises^ chilblains, etc. 

Camphor chloral makes an efficient local application in 7ieur- 
algia, and the campho-phenique is an excellent antiseptic, when 
mixed with oil being an efficient dressing for wouitds. 

Internally. — The disagreeable odor and taste of many of the 
antispasmodics — notably asafetida, valerian, and musk — greatly 
limit their use. Asafetida is an exceedingly valuable stomachic 
tonic, and singularly beneficial in the atonic dyspepsia and constipa- 
tion of nervous and anemic women. It stimulates the appetite and 
digestion, acts as a laxative, and allays much of the nervousness 
and melancholia from which these patients so frequently suffer. 

Asafetida is a peculiarly potent remedy in relieving parox- 
ysms of hysteria, and there is probably no more effective agent 
for the alleviation of flatulent colic of infants and various ijtfantile 
convulsions. 



ANTISPASMODICS. 389 

Chronic bronchitis and bronchorrhea, especially when attended 
with spasmodic dyspnea, are very favorably influenced by this rem- 
edy. Its antispasmodic action renders asafetida of considerable 
value in zvhooping cough and the synipatJietic cougJi of mothers. 
The drug has been highly recommended in chorea occurring in 
young girls about the age of puberty, who are weak, anemic, and 
suffering from menstrual irregularities. The emulsion of asafetida, 
used as an enema, often affords prompt and complete relief in the 
tympanitis of typhoid fever. 

Ammoniacum is chiefly employed as a stimulant expectorant in 
chronic bronchitis. Camphor is a remarkably efficient anodyne, an- 
tispasmodic, and carminative in flatulent colic, diarrhea of hifants, 
and the diarrhea of the aged produced by relaxation of the bowels. 
For many years camphor has been considered a valuable remedy 
in the diarrhea ushering in an attack of Asiatic cholera. 

The various spasmodic and hysterical disorders for which asa- 
fetida is recommended are also greatly benefited by camphor. It 
is, moreover, a serviceable stimulant expectorant and a potent 
remedy, especially monobromated camphor, to allay sexual excite- 
ment and for the relief of chordee. It has likewise proved effica- 
cious in spermatorrJiea. 

Mania, especially the puerperal form, delirimn tremens, and 
melancholia have readily yielded to full doses of camphor. The 
internal use of the drug has appeared to prove beneficial in senile 
gangrene. 

Dysmenorrhea and the after-pains of labor are greatly relieved 
by camphor, either alone or combined with morphine. The drug 
has been used extensively as a cardiac stimulant and to allay the 
delirium and restlessness oi typhoid, typhus, and exanthematous fevers. 

Camphoric acid is an efficient remedy in checking the night- 
sweats of phthisis and excessive perspiration in acute rheu7natism. 
It is recommended by Wood in enuresis and spermatorrJiea. While 
not so efficient as camphor or monobromated camphor in spas- 
modic and hysterical disorders, it has proved of some benefit in 
these conditions. 

Camphoric acid in from i to 2 per cent, solution is useful in 
the treatment oi acute pJiaryngitis and acute coryza,h€vc\'g employed 
in the form of a gargle or spray. 

Camphoric acid has been used internally to acidify ammoniacal 
urine in cystitis. 

Valerian has been employed for the same class of disorders as 



390 A TEXT-BOOK OF MA TERIA MEDICA. 

those treated with asafetida, but seems to be superior to the latter 
in mitigating the hysterical vianife stations and vaso-motor disturb- 
ances occurring at the menopause. 

The hypochondriasis of feeble and morbidly sensitive girls and 
women is usually soon relieved by this remedy. Nervous headache 
and vertigo due to cerebral anemia and the irregular distribution 
of blood are, in the majority of cases, promptly relieved by valerian 
or the ammonium valerianate. 

Valerian has been favorably recommended in both diabetes 
insipidus and mellitus. 

Contraindications. — There are no special contraindications to 
the use of antispasmodics other than in acute inflammations of the 
gastro-intestinal tract, when camphor should not be employed. 

Administration. — Any of the preparations of the various mem- 
bers of this group may be used. Asafetida and camphor in sub- 
stance should always be given in the form of pills or capsules. 
Camphoric acid is best administered in capsules. 



GROUP II.— ANTIPYRETICS. 

AcetanilTdum'— AcetanilTdi— Acetanilid, 

Origin. — An acetyl derivation of Aniline. 

Description and Properties. — White, shining, micaceous, crys- 
talline laminae, or a crystalline powder, odorless, faintly burning 
taste, permanent in air, neutral to litmus-paper. It is soluble, at 
15° C. (59° F.), in 194 parts of water, 5 parts of alcohol, 18 parts 
of boiling water, and in 0.4 part of boiling alcohol; also in 18 
parts of ether, and easily soluble in chloroform. 

Dose. — 2-10 grains (0.1-0.65 Gm.). 

Physiological Action. — Exter?ially and Locally, — Antiseptic, 
slightly sedative. 

^ Antifebrin is a copyrighted name for Aceianilid, or Phenyl- acetamide, as it is 
sometimes called. The copyrighted word Atitifebrin should never be used. The pro- 
prietary preparations like Antikamnia, Antinervin, Phenolyd, Exodyne, etc. are said, 
by different chemists who have analyzed them, to be mechanical mixtures of Acetanilid 
and one or more such substances as Sodium Bicarbonate, Caffeine, Ammonium Bromide^ 
Salicylic Acid, Sodii4??i Salicylate, etc. Such secret preparations should not be counte- 
nanced by medical men. Should a combination containing some of the aforesaid drugs 
be desired, a prescription for the same should be written, specifying the proportions 
wanted in each particular case, rather than prescribe a proprietary article costing a 
dollar or more an ounce, the same mixture being put up by any pharmacist for ten 
cents an ounce. 



ANTIPYRETICS. 391 

Internally. — Digestive Systein. — Non-irritating, sedative ; medic- 
inal doses sometimes allay nausea. 

Circulatory System. — In therapeutic doses acetanilid appears to 
have no action upon the blood. The corpuscles are unaffected 
under the influence of small doses, but toxic doses disorganize the 
corpuscles. When large doses are taken, or even small doses by one 
who has an idiosyncrasy against the drug, the arterial blood becomes 
venous in character, the normal alkalinity of the blood is decreased, 
and much of the hemoglobin is reduced to methemoglobin. 

Heart and Blood-vessels. — In medicinal doses the arterial ten- 
sion is sHghtly raised, while the heart is slowed. Toxic doses 
directly depress the heart and vaso-motor mechanism, causing an 
immediate fall of arterial pressure and great cardiac depression. 

Nervous System. — In medicinal doses acetanilid is a sedative to 
the sensory nerves and spinal cord. Small doses are mildly stim- 
ulant to the brain, and under certain conditions the drug is a 
hypnotic. Toxic doses result in general anesthesia and abolition 
of reflexes, with paralysis of motor and sensory nerves. 

Respiratory System.- — Medicinal doses produce no special effect. 
When toxic doses are given there is a rapid and labored respiration. 
Death is produced by respiratory failure, due to direct action of the 
drug upon the respiratory center, and indirectly by greatly de- 
creasing the oxygen-carrying power of the blood and by paralyz- 
ing the peripheral motor nerves. 

Absorption aitd Elimination. — Acetanilid is an active diuretic, in- 
creasing the excretion of urea, and to some extent the excretion of 
uric acid. After toxic doses have been taken the urine becomes dark 
or brownish in color, from the presence of disorganized corpuscular 
elements of the blood. It is diaphoretic. Acetanilid is chiefly elim- 
inated by the kidneys in the form of sulphate of para-amido-phenol. 

Temperature. — Acetanilid has little or no effect on the normal 
body temperature ; but if the latter is above normal, the drug has 
a marked antipyretic action, often reducing the temperature to 
below normal. This peculiar effect of acetanilid, and of the anti- 
pyretic group in general, is due primarily to the action of the 
drug on the heat-center in the medulla. When the body is in a 
state of hyperpyrexia the heat-center is in a depressed condition, 
owing to certain poisons circulating in the blood, and will not 
respond to the normal limit (98.6°) of body temperature. Acetani- 
lid increases the irritability of the heat- center, causing it to respond 
to a lower temperature, and, through its action on the vasomotor 



392 A TEXT-BOOK OF MATERIA MEDICA. 

center, stimulates the vasodilators, thereby augmenting the periph- 
eral circulation, with consequent increase of heat-dissipation. 

Eye. — Medicinal doses have no apparent influence on the eye. 
Toxic doses have produced contracted and motionless pupils. 

Untoward Action. — Under prolonged use of acetanilid conges- 
tion of the liver, kidneys, and spleen occurs. Paroxysms of 
sneezing have apparently been induced by a medicinal dose, and, 
under the same, redness of the skin, chilliness, and cyanosis have 
sometimes ensued. 

Poisoning. — The skin is cyanosed, the face is livid and anxious, 
and the body is covered with cold sweat. There may be vomiting ; 
the pulse is soft, slow, and weak, accompanied by profound pros- 
tration. The respirations are first rapid and labored, and later slow 
and very shallow, death resulting usually from respiratory paraly- 
sis. After death the heart, liver, and kidneys are found in a state 
of acute fatty degeneration. 

Treatment of Poisoning. — Diffusible stimulants, like alcohol, in 
small doses, ammonia, and sulphuric ether. Coffee, atropine, and 
strychnine hypodermically as circulatory and respiratory stimu- 
lants. External heat and, if necessary, oxygen inhalations to over- 
come cyanosis. 

Therapeutics. — Externally and Locally. — Acetanilid has been 
locally applied for the treatment of chancre and chancroid, but there 
are other antiseptics which are generally considered to be more 
satisfactory. It is quite an active hemostatic, and may be used in 
epistaxis and hemoptysis. 

Internally. — The use of acetanilid in fevers has been practically 
abandoned by the great majority of clinicians. If an antipyretic 
of this character is indicated at all, it is in sthenic fevers, and then 
to be used only with great care. Its tendency to cause cardiac 
depression, profuse sweating, and collapse renders its use harmful, 
if not unsafe, in low conditions like typhoid fever and advanced 
phthisis. It may often be administered with good effect in the first 
stage of pneumonia. The headache, fever, and other unpleasant 
symptoms in the exanthemata are greatly modified by its use, 
although when this drug is given to children they must be very 
carefully watched to avoid untoward effects. 

There is considerable difference of opinion in regard to the utility 
of acetanilid In rheumatism. Some authorities believe that it exer- 
cises a most favorable influence in the acute articular variety, being 
less apt to disturb the brain than salicylic acid or its salts. The 



ANTIPYRETICS. 393 

drug certainly mitigates, and often entirely relieves, the pain and 
swelling, while it reduces the fever. Like salicylic acid, it has no 
power to prevent heart-complications, but, on the contrary, it 
should be used with great care, if at all, when such complications 
exist. It has no tendency to prevent relapses. 

The dose of acetanilid in acute rheumatism should not exceed 6 
grains (0.5 Gm.) three times a day. 

Acetanilid is a very efficient analgesic, and the introduction of 
this drug, antipyrine, and other remedies of this character has 
enabled us to relieve the pains of certain spinal diseases more 
efficiently than was possible before. 

The crises of locomotor ataxia are quite promptly relieved by 
acetanilid. Neuralgias of every kind indicate its use. The pains 
of neuritis, lumbago, gastralgia, dysmenorrhea, sciatica, tabes dor- 
salis, and nearly every kind of headache usually yield to its anal- 
gesic influence. 

In many cases of chorea and epilepsy (especially the diurnal 
variety), and in those cases characterized by full habit and high 
arterial tension, the drug has often been employed successfully. 

Pains which are paroxysmal in character yield best to acetanilid. 
It quiets the excitement in mania a potii, and in exceptional cases 
lessens the paroxysms of whooping cough. 

In doses of 3-5 grains (0.2-0.32 Cc), thrice daily, acetanihd has 
proved efficient as a relief for sea-sickness. It has also been found 
serviceable in traumatic tetanus. 

The author has found it to be of great value in influenza, or " la 
gripped combined or given alternately with salol or sodium salicy- 
late. It is also highly praised in acute brojicliitis. 

Contraindications. — In low fevers, at any rate not in repeated 
doses ; in fatty or dilated heart, blood disorders, advanced tuber- 
cular disease, and exhaustion from hemorrhages. 

Administration. — It may be prescribed in powders, pills, com- 
pressed tablets, capsules, or alcoholic solution. A speedier effect 
is produced if it is taken dissolved in a small quantity of alcohol or 
wine diluted with water. 

The average dose as an antipyretic usually should not exceed 5 
grains (0.3 Gm.) ; as an anodyne, 2-5 grains (0.1-O.3 Gm.). It 
may be repeated at intervals of about four hours or less, according 
to its effects. 

Its action in neuralgias, according to Hare, may be assisted by 
associating it with small doses of monobromated camphor. 



394 A TEXT-BOOK OF MA TERIA MEDICA. 

Antipyrlna— Antipyrlnae— Antipyrine. 

Orig-in. — A Coal-tar derivative. 

Description and Properties. — A white, crystalline powder, 
odorless, of a slightly bitter taste, freely soluble in water, alcohol, 
and chloroform. 

Dose. — 3-20 grains (0.19- 13 Gm.). 

Antagonists and Incompatibles. — Antipyrine is incompatible 
with spirit of nitrous ether and nitrous compounds, the chlorides 
of mercury, the iodides of arsenic and mercury, the ferric salts in 
solution, tincture of iodine, most of the vegetable astringents, car- 
bolic acid, chloral, beta-naphtol, sodium bicarbonate, sodium salicy- 
late, and the salts of quinine and caffeine. 

Synergists. — The same as for other members of this group. 

Physiological Action. — Digestive System. — Antipyrine differs 
from acetanilid in that it often produces vomiting. 

Respiratory System. — In medicinal doses it increases the number 
of respiratory movements. In every other respect it has the same 
action upon the respiration as acetanild. 

Absorption and Elimination. — Kidneys. — Antipyrine lessens the 
amount of urine, urea, and uric acid excreted, but increases the 
amount of sulphuric acid in the urine. Like acetanilid, toxic doses 
cause the urine to assume a dark or brownish color. It is more rap- 
idly eliminated than acetanilid, being detected in the urine within 
three hours after being taken. 

Eye. — Toxic doses have produced amblyopia and hallucinations 
of vision. 

Therapeutics. — The remarks on the therapeutics of acetanilid 
are applicable to this drug, although antipyrine is a more powerful 
antiseptic, analgesic, and local anesthetic. As an analgesic it prob- 
ably ranks next to opium. The anesthesia produced by antipyrine 
often lasts for several hours or even days. In acute coryza and 
inflammation of the phafynx great relief is obtained by spraying 
the parts with a 2 or 4 per cent, solution, after applying a solution 
of cocaine to prevent the primary smarting and irritation which the 
antipyrine produces. 

A 20 per cent, solution has been used in otitis, and a 4 per cent, 
solution has been found very efficient in cystitis. 

Antipyrine has been used with some success in diabetes mellitus 
and malarial diseases, particularly in intermittent fever. It does not, 
however, possess the antiperiodic and specific action of quinine in 
malarial poisoning. 



ANTIPYRETICS. 395 

Administration. — The drug is best given in water or some 
aromatic water or syrup. It may also be given hypodermically. 
In hemorrhage the powdered drug may be appHed locally, or a 
40 per cent, solution, which causes less irritation. From \^2 
grains (0.03-0. 12 Gm.), once or twice a day, is sufficient for 
children. Ordinarily a dose of 5 grains (0.3 Gm.) is sufficient 
for an adult. 

Phenacetin. 

Origin. — A Coal-tar derivative. 

Description and Properties. — A colorless, odorless, tasteless 
powder, or glistening, scaly crystals, sparingly soluble in cold 
water, more or less soluble in boihng water, and freely soluble in 
16 parts of rectified spirits. 

Dose. — I -10 grains (0.06-0.6 Gm.). ' 

Physiological Action. — Phenacetin differs from acetanilid only 
in the following respects : 

Circulatory System. — Small doses increase the force of the heart, 
accelerate the pulse, and raise arterial tension. Large doses affect 
the blood and the circulatory system like acetanilid. 

Kidneys. — It is a diuretic, but not so active as acetanilid. When 
large doses have been taken the urine is dark-yellow in color and 
gives the reaction for sugar. 

As an antipyretic phenacetin is said to be slower in its action 
than acetanihd, nor is it so powerful as an analgesic and hypnotic. 

By many physicians the drug is considered one of the safest 
of the synthetical antipyretics, though in very large doses, accord- 
ing to Hare, it is more apt to disintegrate the blood than either 
antipyrine or acetanilid. It certainly has an advantage over many 
other antipyretics in being tasteless, seldom exciting nausea, exces- 
sive diuresis, diaphoresis, or diarrhea. The author's experience 
leads him to consider it as possessing a briefer antithermic action 
and a greater tendency to produce cyanosis and rigors than ace- 
tanihd or antipyrine. 

Therapeutics. — Phenacetin is given in the same class of diseases 
as acetanihd. 

Contraindications. — The same as for acetanilid. 

Administration. — The drug maybe dispensed in powders, pills, 
capsules, tablets, or suspended in mucilaginous drinks.^ 

* Phenacetin may be adulterated with phenacetidin, a by-product in manufacture and 
a poisonous substance, which in small doses induces kidney trouble. Many of the toxic 



39^ A TEXT-BOOK OF MATERIA MEDICA. 

Phenocoll. 

Origin. — A combination of Para-amido Phenocoll and Glycocoll. 
The phenocoll hydrochloride is the salt used in medicine. 

Description and Properties. — A white crystalline powder, sol- 
uble in 1 6 parts of water, and freely soluble in hot alcohol, forming 
a neutral solution. 

Dose. — 3-15 grains (0.2-1.0 Gm.). 

Incompatibles. — All the alkalies. 

Physiolog-ical Action. — Phenocoll differs from acetanilid in no 
essential particulars other than the following : 

Circulatory System. — Its effect upon the heart and pulse is sim- 
ilar to that of acetanilid, but it has no influence upon the blood 
itself. 

Kidneys. — The excretion of nitrogen in the urine is increased. 

Temperature. — In febrile conditions it produces a decided fall 
of temperature Avithin one hour after its administration by the 
stomach, caused by an enormous diminution of heat-production 
without any marked alteration of heat-dissipation. 

Therapeutics — Experience with phenocoll hydrochloride is yet 
too limited for us to draw any trustworthy conclusions as to its 
safety compared with the antipyretics previously mentioned or re- 
garding its real place in medicine. The results, thus far, have shown 
it to be comparatively safe — probably the safest of all antipyretics — 
and of value internally for all conditions benefited by the previously 
named antipyretics. It is not so valuable an antipyretic and anal- 
gesic in rheumatism as acetanihd or antipyrine, nor is it so efficient 
an analgesic in myelitis, sciatica^ or neuralgia ; but, on the other 
hand, it far surpasses these drugs in the treatment of intermittent 
fever, ranking next to quinine in malarial disorders. 

Pelletini, indeed, regards it as superior to all antimalarial reme- 
dies, and Bonetti considers it a real substitute for quinine. 

symptoms of acetanilid so closely resemble aniline-poisoning as to suggest the production 
of that substance in the blood. There is a close relationship between the two bodies, 
and there is some ground to suspect the occasional presence of aniline in samples. The 
important question of adulteration and impurity should not be lost sight of in consider- 
ing the ill effects of any drug. In the experience of the author, better results, in every 
particular, have been obtained from antipyrine than from either of the other antipyretics 
mentioned, so that he almost invariably uses it, both for adults and children, believing it 
the safest drug of its class, as well as the most certain and uniform in its action. 

These drugs are unquestionably given in too large doses by the majority of physi- 
cians, and persons suffering from high temperature are more susceptible to their untoward 
mfluences — like cyanosis, collapse, etc. — than those whose temperature is normal. 



ANTIPYRETICS. 397 

Phenocoll possesses the advantage of not producing the un- 
pleasant effects of quinine. It is a powerful antiseptic, and may- 
be applied locally where a drug of that character is indicated. 

Contraindications. — Probably the same as for acetanilid. 

Administration. — Locally, the drug may be employed in solu- 
tion or in the form of an ointment in strengths varying from 5 to 
20 per cent. Internally it may be administered, in the doses recom- 
mended, from three to five times a day, in powders, aqueous solu- 
tion, or in capsules. 

Exalgine (Methylacetanilide). 

Orig-in. — As the chemical name indicates, this substance is 
a derivative of Acetanilid. 

Description and Properties. — Exalgine occurs in colorless 
needles or prisms, inodorous and tasteless. It is neutral to test- 
paper, and is freely soluble in alcohol, chloroform, carbon disul- 
phide, and boiling water. It requires about 60 parts of cold water 
or 10 parts of ether for solution. 

Dose. — 2-4 grains (0.1-0.2 Gm.). 

Antagonists and Incompatibles. — Exalgine is incompatible 
with the iodides, salicylic acid, and solution of potassa. 

Synergists. — All members of this group, as well as opium, 
cocaine, belladonna, and hyoscyamus. 

Physiological Action. — Exalgine is almost identical in its action 
with acetanilid, with the exception that it possesses less antipyretic 
power. In medicinal doses the drug increases arterial tension, and 
in full doses profoundly affects the cerebro-spinal axis. It is more 
uncertain than, and not so safe as, either of the drugs previously 
mentioned. 

Therapeutics. — Exalgine should never be employed as an anti- 
pyretic, but as an analgesic it may be given for the same purposes 
as acetanilid and antipyrine. Good results have been reported in 
the treatment of chorea by this drug. 

Contraindications. — The same as for other agents of this group, 
and, in addition, fever, it is said, contraindicates its use. 

Administration. — Exalgine may be administered either in pow- 
ders or capsules, but the doses should not be given at frequent 
intervals, from six to seven hours elapsing between them, and only 
in exceptional cases should more than 10 grains (0.16 Gm.) be 
given in twenty-four hours. 



398 A TEXT-BOOK OF MATERIA MEDICA. 

GROUP III.— ANESTHETICS. 

As heretofore defined, these are substances having the property 
of destroying sensation, or producing anesthesia, either general or 
local. 

To Dr. Oliver Wendell Holmes is due the credit of proposing 
the term " anesthetic." This group naturally occupies the place 
between the preceding one and the next — Hypnotics. As before 
stated, there exists a close chemical relationship between antiseptics, 
antipyretics, anesthetics, hypnotics, and analgesics. The first two 
of these possess marked anesthetic and analgesic properties. The 
drugs included in the present group should properly be classed as 
general anesthetics, possessing more nearly the characteristics of 
typical anesthetics. 

An ideal agent of this description should be a substance capable 
of rapidly and safely producing profound anesthesia, and susceptible 
of speedy elimination, so that consciousness may be restored soon 
after the withdrawal of the anesthetic, with no discomfort to the 
patient. 

The typical anesthetic should also be convenient and safe — 
a stable, non-irritating, pleasantly odorous, homogeneous liquid, 
with a boiling-point neither too high nor too low. Unfortunately, 
there is no substance which fully meets these requirements, ether 
and chloroform approaching nearest to the ideal agent. 

The general anesthetics, with the exception of nitrous oxide, 
all belong to the class of alcohols and ethers. Indeed, alcohol, 
although in this work not classed among anesthetics, possesses 
marked anesthetic properties, as well as others — antiseptic, anti- 
pyretic, etc. — characteristic of these drugs. 

It has been stated by Dr. Richardson that the first recorded 
case of the use of an anesthetic in surgery was that of Dr. Collier 
in 1839, who anesthetized his patient by causing him to inhale the 
fumes of alcohol. 

It has been well known for centuries that alcohol, when taken 
in large quantities, possesses the power to lessen pain and sensa- 
tion. The anesthesia produced by this drug, however, is too tardy 
and prolonged to render it practically serviceable. 

General anesthetics abolish sensation throughout the whole 
body by destroying the sensibility of the nerve-centers — directly, 
by affecting the nervous tissue, or indirectly, by influencing the cir- 
culation, or the blood, in such a manner as to interfere with the 
functional activity of the nerve-cells. 



ANES THE TICS. 399 

The detailed action and uses of anesthetics are fully described 
under " yEther " and *' Chloroformum." 

Local anesthetics are used to deaden the sensation or abolish 
the sensibility of the peripheral nerves of a locahzed, particular 
area. The most important are — cocaine, carbolic acid, iodoform^ 
eugenol-acetamide, and antipyrine. Some aromatics are also quite 
powerful anesthetics. The physiological action of local anesthetics 
is given under the respective agents. 

v^ther—>^theris— Ether. U, S. P. 

Origin. — A hquid composed of about 96 per cent, by weight 
of Ether or Ethyl Oxide, and about 4 per cent, of Alcohol con- 
taining a little Water. 

Ether is known as sulphuric ether, and was called yStke?"- For- 
tior by the Pharmacopoeia of 1880. 

Description and Properties. — A transparent, colorless, mobile 
liquid, having a characteristic odor and a burning, sweetish taste. 
Specific gravity, 0.725-0.728. Soluble in about ten times its vol- 
ume of water, with slight contraction of bulk. Miscible, in all pro- 
portions, with alcohol, chloroform, benzin, benzol, and fixed and 
volatile oils. 

Ether is highly volatile and inflammable, its vapor, when mixed 
with air and ignited, exploding violently. It should be kept in 
well-stoppered contamers, preferably in tin cans, in a cool place, 
remote from hghts or fire. 

Dose. — 15-40 minims (1.0-4.0 Cc). 

Official Preparations. 

Spiritus Athens — Spiritus i^theris — Spirit of Ether. — Dose, \-\ fluidrachm 
(1.0-4.0 Cc). 

Spiritus .^theris Compositus — Spiritus .^theris Comp6siti — Compound 
Spirit of Ether (Hoffmann's Anodyne). — Ether, 325; Alcohol, 650; Ethereal Oil, 
25 parts. Dose, 5-60 minims (0.3-4.0 Cc). 

Antagonists and Incompatibles. — The stimulant and anodyne 
action of ether is antagonized by the arterial sedatives, the tetaniz- 
ing alkaloids, strychnine, picrotoxin, etc. 

Synergists. — The arterial and cerebral stimulants, chloroform 
and other anesthetics, and alcohol. 

Physiolog-ical Action. — Externally and Locally. — Ether when 
applied to the skin produces intense cold by its rapid evaporation. 
If it is confined and its evaporation prevented, great irritation is 



400 A TEXT-BOOK OF MATERIA MEDICA. 

excited. By spraying a part with ether it becomes quickly frozen, 
marked local anesthesia being produced thereby. 

Apphed to mucous membranes, it creates considerable irritation, 
especially of the fauces and respiratory tract when inhaled. 

Internally. — Digestive System. — It is a carminative, increasing 
peristalsis and the secretions from the pancreas and the salivary 
and gastric glands, at the same time dilating the vessels of the 
stomach. 

Circulatory System. — When taken into the stomach ether re- 
flexly stimulates the heart in a manner similar to that of alcohol, 
raising arterial tension by increasing the force and frequency of the 
heart's action. 

Ether stimulates the heart and increases the blood-pressure when 
inhaled. It is a diffusible, rapid, and reliable cardiac stimulant. In 
very large or poisonous amounts it exhausts the heart by over- 
stimulation, acting as a cardiac depressant. 

Nervous System. — Ether first occasions a considerable degree 
of excitement, due to the direct action of the ethyl upon the cere- 
bral cortex. Its action in this respect is analogous to that of 
alcohol, and, like the latter drug, it affects the nervous system in a 
certain order, primarily stimulating and afterward depressing, first, 
the cerebral hemispheres ; second, the sensory areas of the spinal 
cord ; third, the motor areas of the spinal cord ; fourth, the sensory 
centers of the medulla oblongata ; and, finally, the motor areas of 
the medulla. The motor nerves and muscles are unaffected. 

Respiratory System. — Medicinal doses stimulate and poisonous 
doses paralyze the respiratory center. 

Respiration is frequently arrested at the beginning of ether- 
inhalation, owing to reflex spasm arising from irritation of the 
peripheral ends of the vagi and trigemini. As the inhalation is 
continued the breathing becomes deeper and faster from stimula- 
tion of the respiratory center. This part of the nervous system 
may, in fact, become exhausted from over-stimulation, when the 
respirations are slow and shallow. 

In fatal cases of ether-narcosis the respiration is usually arrested 
before the cessation of the heart's action. 

Absorption and Elimination. — Ether is rapidly eliminated, chiefly 
by the lungs, but also by the kidneys, which are often considerably 
irritated by the process. 

Temperature. — The prolonged administration of ether produces 
a great reduction of temperature— doubtless due to the depression 



ANESTHETICS. 401 

of the circulation and respiration and the rapid evaporation of the 
drug chiUing the body and lungs, rather than to any direct action 
upon the nervous mechanism presiding over the heat-centers. 

In brief, the action of ether when inhaled is as follows : At first 
a sensation of choking and irritability of the respiratory mucous 
membrane is experienced. A greatly mcreased activity of the sali- 
vary glands follows, accompanied by a sensation of pricking or 
tingling of the hands and feet. The conjunctiva is injected, the 
face is flushed, the veins of the neck are distended, and there is 
experienced a peculiar feeling of Hghtness, together with a perver- 
sion of all the senses, due to emotional excitement. The patient 
may yell, laugh, cry, curse or pray, struggle or become pugilistic, 
while the breathing may be spasmodic or stertorous, the pulse 
becoming rapid and strong. 

As the inhalation is continued the respiration is quickened, the 
skin becomes moist and warm, and relaxation of the muscles en- 
sues, with abolition of reflexes, contracted pupils, and complete 
suspension of sensation. Finally, as perfect unconsciousness super- 
venes, the pupils are dilated ; the respiration is slow and deep, and 
later very weak ; and the skin is cool and moist. 

If the inhalation be discontinued before a toxic quantity of ether 
has been administered, consciousness gradually returns — in some 
cases almost at once, although some loss of sensation and muscular 
weakness remain for a while. 

The return of consciousness is usually accompanied by retching 
and vomiting — often by severe rigors, unless care has been taken 
to keep the patient warm. Great excitement not infrequently 
attends this stage of etherization. 

Treatment of Untoward Manifestations. — Withdraw the ether if 
there be danger of respiratory or cardiac failure, lowering the head 
if there be indications of the latter, and if respiratory failure be 
threatened, as indicated by cyanosis, avoiding a prostrate position. 
Meanwhile, other measures for the relief of cardiac or respiratory 
failure may be resorted to : artificial respiration, friction, or the 
electric current to excite respiratory action, one electrode being 
placed upon the larynx and the other upon the epigastrium. Hy- 
podermic injections may be resorted to — of strychnine, digitalis, or 
atropine, or, in desperate cases, of ammonia. 

When asphyxia is produced by the lodgement of mucus in the 
respiratory passages, the hypodermic injection of ether itself is per- 
missible, if necessary, to excite more vigorous respirations. 



402 A TEXT-BOOK OF MATERIA MEDIC A. 

Should nausea become too persistent, a hypodermic injection of 
morphine will usually suffice to quiet it. 

Ice-water or a little ether poured over the epigastrium will 
establish regular respirations when suspended, as is often the case, 
during the first stage of anesthesia. 

Therapeutics. — Externally a7id Locally. — The hypodermic in- 
jection of 15 minims (i.o Gm.) of ether in close proximity to the 
affected nerve has been found valuable in neuralgia and sciatica. 

The hypodermic method of administration has been also prac- 
tised in the treatment of shock and in the threatened collapse fol- 
lowing post-partinn hemorrhage, as well as for the cure of sebaceous 
cysts. 

The local anesthetic properties of ether render it valuable in 
many diseases of the skin^ such as pruritus, urticaria, etc. For 
treatment of these disorders it is usually combined with some 
aromatic. 

A wet compress saturated with ether has been successfully 
applied to the forehead for the relief of epistaxis. 

Internally. — Ether is used as an antispasmodic in order to facili- 
tate certain examinations, the reduction of dislocations, and to 
relieve pain in the general practice of surgery, obstetrics, and den- 
tistry. 

It has been used as an anthelmintic against tape-worms. 

The compound spirit of ether is a stimulant, antispasmodic, 
and anodyne. It is an efficient remedy for gastralgia and flatulent 
colic, and is used to allay many of the symptoms of hysteria, as well 
as restlessjzess and insomnia unaccompanied by fever. Palpitation of 
the heart and nausea due to the excessive use of tobacco are also 
greatly benefited by this preparation. In angina pectoris and hic- 
cough it is an efficient remedy. 

Contraindications. — -Acute or chronic disease of the kidneys. 
Dilatation or fatty degeneration of the heart. Disease of the 
lungs. Tumors of the brain or about the neck. Atheromatous 
condition of the arteries. Enlarged tonsils, chronic alcoholism, 
or aneurysm. 

It is necessary at times to give an anesthetic in the foregoing 
cases, and the surgeon is justified in the use of ether, but the 
administration should be extremely careful and conducted under 

skilful suoervision whenever the above contraindications exist — 

i. 

particularly in conditions of dilated or fatty heart or chronic 
alcoholism. 



ANESTHETICS. 403 

Administration. — In administering anesthetics the following 
precautions should be taken : 

The stomach of the patient should contain no undigested food. 

The clothing should be loose about the neck, thorax, and ab- 
domen, allowing perfect freedom of respiration. 

Artificial teeth should be removed. 

It should be remembered that ether is inflammable, and, when 
its vapor is mixed with air, explosive : it should, therefore, not be 
used near a flame or an actual cautery, from which it may ignite. 

The patient should be kept covered, in order that there may not 
be too great a reduction in temperature. He should, moreover, be 
watched for several hours after the administration, since there is 
always more or less danger until the effects of the ether have 
entirely disappeared. 

Under proper methods the administration of ether occasions 
little inconvenience. In addition to the recommendations above 
given, it may be added that smearing the mouth and nose with 
oil prevents the excoriation frequently occasioned by contact with 
the anesthetic. 

There are various means of administration, the simplest and in 
many cases the most efficient being a towel shaped into a funnel or 
hollow cone, with a piece of stiff paper laid between the outer folds 
to preserve the shape. Among many mechanical contrivances the 
inhaler of Dr. O. H, Allis of Philadelphia is perhaps the best. At 
the Massachusetts General Hospital a cone-shaped sponge is 
employed. 

In using the towel-cone the inner surface is saturated with 
about half an ounce of ether, the inhaler at first not being placed 
close to the mouth and nose, thus allowing the vapor to be suf- 
ficiently diluted with air. The effect of this method is to accustom 
the air-passages to the primary irritation of the anesthetic and 
graduate its effects. After this the towel may be pressed close to 
the mouth and nose and the concentrated ether freely adminis- 
tered. In this manner a person may become completely etherized 
without nausea or resistance. The insensibility of the conjunctiva 
and complete relaxation of the muscles, accompanied by semi- 
stertorous breathing, indicate that the stage of desirable anesthesia 
is attained. The quantity of ether administered should now be 
reduced, further supplies being hmited to the amount requisite to 
maintain complete anesthesia. 

The symptoms incident to the primary effects of etherization — 



404 A TEXT-BOOK OF MATERIA MEDICA. 

cerebral excitement, muscular activity, etc. — should not induce 
withdrawal of the anesthetic, but rather its continuance. Should 
vomiting occur at this stage, etherization should be suspended 
and the mouth thoroughly cleansed by means of a sponge or a 
towel. 

Complete loss of consciousness marks the following stage of 
anesthesia, when total relaxation supervenes, accompanied by 
gentle, regular breathing. Should stertorous respiration attend 
further etherization, it is a warning of paresis, and the drug should 
be withdrawn. 

Congestion of the facial muscles during anesthesia is quite 
normal, pallor, as a rule, indicating cardiac or respiratory debility. 
The practice of closely covering the face is thus to be discouraged, 
since it conceals important symptoms of the patient's physiological 
condition. The danger from asphyxia in complete etherization is 
shown by the entire muscular relaxation of the tongue, which is 
prone to drop backward, and the closing of the glottis, suspending 
respiration. In such an occurrence the jaw should be pressed for- 
ward, the head being well extended, and, if necessary, the tongue 
brought forward with the forceps. 

Under favorable conditions from five to twelve minutes are re- 
quired to etherize the patient completely. The effects of anesthesia 
upon recovery vary with the temperament and character of the 
individual and the conditions under which the drug is administered. 
Great excitability may attend awakening from etherization, or the 
patient may return to consciousness as from a tranquil slumber. 
Nausea and vomiting frequently accompany rallying from the 
narcosis — not, however, such as may require especial treatment. 
Should somnolence be manifested, it is best not to rouse the 
patient, that the awakening may be easy and natural. 

In etherizing a female patient the presence of a woman is always 
desirable, in order that her testimony may assuage certain abnor- 
mal impressions to which women during anesthesia are prone, the 
hallucinations being more readily dispelled by one of their own 
sex. To the operator and attendants her presence is also of 
importance. 

Great care should be taken to see that the patient is well cov- 
ered and not exposed to drafts, in its relaxed condition the body 
being peculiarly susceptible to pneumonia or pleurisy. The anes- 
thetic should be carefully examined before administration, and the 
character of the drug thoroughly known. 



ANESTHETICS. 405 

Chloroformum— Chloroform i— Chloroform. V, S. P. 

Origin. — A liquid consisting of from 99 to 99.4 per cent., by 
weight, of Absolute Chloroform, and from i to 0.6 per cent, of 
Alcohol. 

Description and Properties. — A heavy, clear, colorless, mobile, 
and diffusible liquid, of a characteristic ethereal odor and a burning 
taste. Specific gravity, not below 1.490. Soluble in about 200 times 
its volume of cold water, and in all proportions in alcohol, ether, 
benzol, benzin, and fixed and volatile oils. 

Chloroform is volatile, even at a low temperature, and boils at 
60° to 61° C. (i40°-i4i.8° F.). It is not inflammable, but its 
heated vapor burns, emitting a green flame. It should be kept in 
dark, amber-colored, glass-stoppered bottles, in a cool and dark 
place. 

(See tests for chloroform in U. S. Pharmacopoeia, p. 88.) 

Dose. — 2-15 minims (o.i 2-1.0 Cc). 



Official Preparations. 

Aqua Chlorof6rmi — Aquae Chlorof6rmi — Chloroform Water. — Dose, 1-4 
fluidrachms (4.0-16.0 Cc). 

Emiilsum Chloroformi — Emiilsi Chlorof6rmi — Chloroform Emulsion. — 
Dose, 1-4 fluidrachms (4.0-16.0 Cc). 

LinimSntum Chloroformi — Linimenti Chlorofdrmi^ — Chloroform Liniment. 
— For external use. Chloroform, 30 ; Soap Liniment, 70 parts. 

Spiritus Chloroformi — Spiritus Chloroformi — Spirit of Chloroform. — Dose, 
10 minims-i fluidrachm (0.6-4.0 Cc). 

Unofficial Preparations. 

Chlorodyne. — This preparation was first introduced by Dr. Collis Browne of Lon- 
don. Numerous formulae for chlorodyne have been published, the British Pharmacopoeia 
containing an official preparation, Tindura Chloroformi et Morphines, intended as a 
substitute for chlorodyne, and composed of chloroform, ether, alcohol,' morphine 
hydrochlorate, dilute hydrocyanic acid, oil of peppermint, fluid extract of liquorice, 
treacle, and syrup. Dose, 10 minims (0.6 Cc). Parke, Davis & Co. of Detroit, 
Mich., prepare a similar and excellent compound known as Chlor- Anodyne. 

The different preparations of chlorodyne and its substitutes vary greatly in the dose, 
from 5 minims to I fluidrachm (0.3-4.0 Cc) ; in prescribing, therefore, the strength of 
the agent should be ascertained. Remedies of this character possess powerful narcotic, 
anodyne, and antispasmodic properties, and should be administered cautiously and only 
under the direction of a physician. 

In addition to the above, there is an efficient carminative and antispasmodic known 
as Tinctura Chloroformi Composita (B. P.) — dose, 20 minims- 1 fluidrachm (1.2-4.0 
Cc.) — containing chloroform and compound tincture of cardamom and various anesthetic 
mixtures; and chloroform ointments of different strengths. 



4o6 A TEXT-BOOK OF MATERIA MEDICA. 

Antagonists and Incompatibles. — Chloroform will not mix 
with weak spirits or glycerin. Circulatory and respiratory stimu- 
lants and galvanism antagonize to some extent its poisonous action. 
There is no chemical antidote. 

Synergists. — Anesthetics, alcohol, morphine, chloral, and many 
of the hypnotics. 

Physiological Action. — Externally and Locally. — Its action is 
similar to that of ether, though when confined on the skin it pro- 
duces vesication. It is more of an irritant to mucous membranes than 
ether, yet when inhaled it is less irritating to the respiratory tract. 

Internally. — Digestive System,. — Its action upon the digestive 
tract is nearly identical with that of ether, except that when taken 
in a concentrated form it occasions marked irritation of the stom- 
ach and intestines, often resulting in violent gastro-enteritis. 

Circulatory System. — Chloroform depresses the heart and cir- 
culation, the former by weakening the cardiac muscle, and the 
latter by lowering arterial pressure by depressing the vaso-motor 
center. It frequently produces an intermittent pulse by stimulating 
the inhibitory ganglia of the heart. 

Nervous System. — It affects the brain and spinal cord in the 
same manner and order as ether, like it producing death, usually 
by respiratory failure, though sometimes the heart first succumbs 
to the influence of the drug. 

When locally applied the sensory and motor nerves are affected 
in the same manner as by ether. Small amounts of chloroform 
stimulate, and large quantities depress, the nervous system. 

Respiratory System. — Its action closely resembles that of ether, 
though its operation is more rapid and powerful. 

Absorption and Elimi?iation. — Chloroform affects the kidneys by 
irritation, certain investigators claiming that acute nephritis ensues, 
blood and albumin being often present. 

Temperature. — It depresses the temperature, although probably 
by a different action from that of ether, reducing bodily tempera- 
ture by lessening heat-production and increasing heat-dissipation. 

Untoward Action. — If there be any marked idiosyncrasy against 
chloroform, death usually occurs suddenly after a few inhalations 
of the drug. 

When applied externally there is produced not infrequently an 
urticaria- like eruption or an eczematous condition of the skin; 
vesicles may result. If applied to sensitive portions of the skin, 
such as the scrotum, severe and persistent pain is sometimes occa- 



ANES THE TICS. 407 

sioned. Frequently, when applied to wounds and mucous mem- 
branes, it causes intense irritation, so much so that the mucous 
membrane may be shed in pieces. 

The symptomatic manifestations of chloroform-anesthesia, the 
methods of administration, and the treatment of chloroform acci- 
dents are here given in detail. 

The phenomena attending the administration of chloroform in- 
dicate three separate stages of narcosis. The first of these is allied 
to intoxication induced by alcoholic stimulants. In this stage, 
although sensation is dulled, consciousness is retained, and, al- 
though the period is brief as a rule, in some patients, such as those 
of intemperate habits, it may last for some time and be accom- 
panied by violent excitement. In such cases the administration 
of chloroform is attended with no little danger. 

The second stage, available for surgical operations, is one of 
complete anesthesia. The patient is perfectly passive, conscious- 
ness and sensation being for the time wholly obliterated. 

The third stage is the most delicate to deal with, profound un- 
consciousness, with stertorous breathing and total muscular relaxa- 
tion, as well as temporary annihilation of reflexes, indicating the 
danger-line of anesthesia. Only under extreme necessity should 
the administration be carried thus far. 

It is well to guard against taking the pulse as an infallible guide 
to the patient's condition. In each successive stage the cardiac 
movements are variable, although, generally speaking, certain 
pulsations accompany the above-named degrees of narcosis. 

As has been suggested in the case of ether, a few precautions in 
the administration of chloroform are obvious — that there be no 
undigested food in the stomach ; that the clothing be loose about 
the neck, chest, and abdomen ; and that artificial teeth be removed. 

The appliances used in producing anesthesia by the aid of 
chloroform are various, the simplest, as in the administration of 
ether, being a cone formed of a napkin or a towel enclosing a sponge 
or not, a sponge alone, or a handkerchief, upon which a small 
quantity of chloroform — not exceeding from a half to one fluid- 
drachm (2.0-4.0 Cc.) at a time — is poured. The utmost vigilance is 
requisite in the administration, the respiration, pulse, and facial 
indications being constantly observed ; a supply of air being 
allowed to mingle with the anesthetic to obviate the dangerous 
effect of its concentrated vapor; and the drug being instantly 
withdrawn upon the slightest indication of untoward symptoms, 



4o8 A TEXT-BOOK OF MATERIA MEDICA. 

such as lividity of the face, debility of heart-pulsations, and ster- 
torous or spasmodic respiration, and an ominous dilatation of the 
pupils. 

Should respiration cease, the tongue should immediately be 
brought forward or the lower maxillary manipulated as in the case 
of ether. Should these resources be unavailing, artificial respira- 
tion or the galvanic current should be tried. To restore cardiac 
action nitrite of amyl may be used, or hypodermic injections of 
ammonia or digitalis as a cardiac stimulant. 

A mixture of ether and chloroform has been suggested by com- 
petent authorities as the safest and most eflficient anesthetic. Yet 
its utility in many cases has proved doubtful, experience in opera- 
tive surgery rather inclining to the use of a single agent. 

Although the symptomatic features of chloroform-narcosis, 
especially those which accompany collapse and death, have been 
studiously examined, the conditions causing disaster are still but 
imperfectly understood. Nevertheless, premonitory indications are 
seldom wanting which mark clearly enough the limit of safety in 
administration. Of these, extreme mydriasis and failure to pro- 
duce reflex action in the conjunctiva are alone symptoms to be 
regarded with the gravest apprehension. 

The statistics of deaths from chloroform present a melancholy 
yet instructive spectacle to the thoughtful physician, and the deduc- 
tions drawn from them go far to show the value of exceeding cau- 
tion in the use of so subtle and powerful an anesthetic. The 
pathological considerations of any given case fail to throw light 
upon the immediate cause of the patient's collapse, the cessation 
of respiration or stoppage of the pulse resulting in syncope or 
asphyxia varying in their mutual order and coincidences. 

It is not to be inferred that chloroform is of itself necessarily 
dangerous, its noxious effects depending upon its administration 
rather than upon the drug. An instance of its harmless use is 
found in the method of producing partial and temporary anesthesia 
adopted by some physicians in cases of childbirth, neuralgia, etc., 
by which the patient is permitted to administer the anesthetic. 
This method consists in saturating with chloroform a small sponge 
placed in a cup or tumbler, and allowing the patient to inhale the 
fumes at will. Before the system can absorb a lethal quantity of 
the drug muscular relaxation intervenes and the hand involuntarily 
drops, the semi-conscious state meanwhile dulling sensation and 
causing the patient to forget pain. Upon the return of conscious- 



ANESTHETICS. 409 

ness the administration may be repeated, with little danger of un- 
toward results from the small amount of chloroform inhaled. The 
bottle, it is hardly necessary to say, should never be entrusted to 
the patient. 

Additional Anesthetics, and their Comparative Value. 

Ethyl Bromide. — A colorless, inflammable liquid, with a burn- 
ing taste and an odor like that of chloroform. It is readily decom- 
posed, with evolution of bromine. Its action is uncertain, causing 
great irritation of the respiratory passages, and usually producing 
death by paralysis of respiration. 

Ethyl Chloride. — A volatile, colorless, and inflammable Hquid 
having a pleasant odor. It is a very fugacious anesthetic, greatly 
depressing the heart and respiration, and is mainly used, in the 
form of a spray, to produce local anesthesia. 

Ethyl Iodide. — A liquid anesthetic, similar in its physiological 
action to chloroform. Anesthesia produced by it, however, is more 
tardy, although more permanent. It is considered a comparatively 
safe and efficient anesthetic to relieve spasm of the respiratory 
passages, as in asthma and laryngitis. 

Ethylene Bichloride. — More rapid and powerful in its action 
than chloroform, though not so safe, affecting the respiratory center 
invariably before influencing the heart. While speedier in its action 
than ether, it is probably more dangerous. 

Ethylene Bromide. — A weak yet dangerous anesthetic, greatly 
depressing the respiratory center, and tending to cause paralysis 
of the extremities and stoppage of the heart. 

Ethylidene Chloride. — A non-inflammable liquid resembling 
chloroform in its physical appearance, and in its physiological 
action as well, although much less depressant to the heart. It 
causes more irritation to the respiratory passages, with vomiting 
and great languor and discomfort as its sequelae. 

Ethylene Iodide. — A crystalline substance, its fumes when 
heated producing anesthesia, with great irritation of the respiratory 
passages, and death by asphyxia. 

Methyl Chloride. — A colorless, inflammable gas, with a taste 
and odor resembling those of ether and chloroform. Cold lique- 
fies it. It is used locally to produce anesthesia and to relieve pain 
in neuralgia. 

Methylene Bichloride. — A colorless liquid, its odor being like 
that of chloroform. Exposure to the light decomposes it. Anes- 



4IO A TEXT-BOOK OF MA TERIA MEDICA. 

thesia produced by this agent is accompanied with comparatively 
Httle irritation of the respiratory tract, but it occasions a primary 
stage of excitement Hke that induced by ether, and, as in the case 
of chloroform administration, vomiting is likely to ensue. Death 
takes place from paralysis of the heart. The numerous fatalities 
which have occurred under this anesthetic indicate the danger of 
its use, and its volatility renders its employment difficult in a hot 
atmosphere. 

Carbon Tetrachloride — Tetrachlormethane. — A transparent, 
colorless liquid, of an agreeable aromatic flavor, analogous in its 
action to chloroform, but less irritating, although far more danger- 
ous to the heart. 

Formic Ether. — A thin, colorless, inflammable Hquid, of strong,, 
agreeable odor and pungent taste. It acts like chloroform, though 
the signs of asphyxia are less marked. Its effects last for several 
hours. 

Methylic Ether. — A colorless, inflammable gas, heavier than 
air, of an ethereal odor and aromatic taste. Richardson considers 
it a safe anesthetic, though objectionable because of its odor — less 
agreeable than those of ether and chloroform — and the rapidity 
with which it volatiHzes from its solution. 

Methylal — Methylen — Dimethyl Ether. — A highly volatile, 
colorless, limpid liquid, of penetrating ethereal odor. It is used 
chiefly as a local anesthetic and as an efficient hypnotic in insanity 
and delirium tremens. 

Acetic Ether (U. S. P.). — A colorless, Hmpid, volatile liquid 
having an agreeable, refreshing, ethereal, and somewhat acetous 
odor and taste. It has the advantage over sulphuric ether of being 
less inflammable and less volatile. Owing to its pungent and 
agreeable odor, too, it is superior to the latter drug in stimulating 
the nasal passages in cases of syncope and nervous agitation. 

Pental. — A colorless, volatile, inflammable hquid, insoluble in 
water, but miscible in all proportions with alcohol, ether, and chlo- 
roform. It has a mustard-like odor, and is comparatively free from 
danger. When poisonous amounts are administered the pulse is 
quickened, the respiration embarrassed, and death ensues from 
paralysis of the heart. It resembles chloroform rather than ether, 
but is less irritating and seldom accompanied by unpleasant after- 
effects. It requires but about 5 drachms (20.0 Cc.) to produce 
anesthesia, which occurs in from two to three minutes. 

There is a difference of opinion as to the safety of pental, some 



ANESTHETICS. 



411 



physicians considering it less dangerous than chloroform, and others 
regarding it as less efficient and not so safe. 

Nitrous Oxide ("Laughing" Gas"). — A colorless gas, of a very- 
slight, agreeable odor and sweetish taste. It is not inflammable, 
but supports combustion of ignited bodies. Pressure and cold 
condense it into either a thin, colorless, very mobile liquid or 
colorless crystals. It is a rapid anesthetic, unconsciousness being 
produced in from one-half a minute to three minutes. The pulse is 
strong and quick, the respirations frequent and shallow, while, as 
the inhalation continues, the breathing becomes stertorous and the 
face is cyanotic. If the inhalation be interrupted or the gas mixed 
with air, symptoms of intoxication are manifested, accompanied by 
a high degree of mental excitement. It is a very safe anesthetic, 
but the anesthesia is of quite short duration, rendering it valuable 
mainly for the extraction of teeth and in minor surgery. 

The comparative value of ether and chloroform may be sum- 
marized as follows : 

1. If an anesthetic be required, ether is preferable in the case 
of a patient suffering from a weak cardiac action or an organic 
disease of the heart. 

2. For operations about the face or of the stomach, as there is 
less danger of reflex inhibition of the heart, ether is preferable to 
chloroform. 

3. Ether is preferable as an anesthetic in the extraction of teeth, 
chloroform being more apt to cause cardiac paralysis, reflexly by 
way of the dental nerve to the root of the vagus, and through the 
vagus to the inhibitory ganglia of the heart-muscle. 

4. Ordinarily, ether is superior to, and safer than, chloroform as 
an anesthetic for adults, unless some special contraindication exist, 
there being less danger in ether of cardiac failure, to which adults 
are more liable. 

Chloroform is much superior to ether in — 

1. Obstetrics, since the use of it is attended with less depression 
and irritation of the respiration and respiratory tract. Moreover, 
chloroform produces less nausea and vomiting, and may be admin- 
istered by the patient herself under proper directions. 

2. It is preferable in anesthetizing children, being more rapid in 
its action and less potent as a respiratory depressant, the respiratory 
center of the child being more susceptible than that of the adult, 
and in children the danger of cardiac paralysis being sHght, 



412 A TEXT-BOOK OF MATERIA MED/CA. 

3. Should the patient be suffering from nephritis, chloroform is 
preferable as an anesthetic, since it is less irritating to the kidneys. 

4. Should an anesthetic be required for patients afflicted with 
pulmonary tuberculosis, empyema, or other disease of the lungs, 
chloroform should be used, since its effect upon the respiratory 
system is less depressing. 



GROUP IV.— HYPNOTICS. 

Chiaral-Chloralis— Chloral. U. S. JP. 

Origin. — A crystalline solid composed of Trichloraldehyde or 
Chloral (an unstable, oily, and colorless fluid), with i molecule of 
Water, forming the Hydrate of Chloral, the official preparation, 
and the only one used in medicine. Chloral itself is prepared by 
the action of Chlorine upon Alcohol, whence the name chlor-al. 

Description and Properties. — Chloral hydrate occurs as sepa- 
rate, rhomboidal, colorless, transparent crystals, having an aromatic, 
penetrating, and slightly acrid odor, and a bitterish, caustic taste. 
It is sHghtly volatilized when exposed to the air, and is freely solu- 
ble in water, alcohol, and ether, being also soluble in chloroform, 
benzol, benzin, carbon disulphide, and fixed and volatile oils. It 
liquefies when triturated with an equal quantity of camphor, 
menthol, thymol, or carbohc acid. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Unofficial Preparations. 

The proprietary preparation known as Bromidia contains to each drachm (4.0 Cc.) 
15 grains (i.o Gm.), each, of Chloral and Potassium Bromide, together with a small 
quantity of Extract of Hyoscyamus and Extract of Cannabis Indica. 

Camphorated Chloral. — Equal parts of Chloral and Camphor. A colorless liquid, 
of syrupy consistence, soluble in alcohol, ether, chloroform, glycerin, and fixed oils, and 
also in aqueous solutions of chloral. It is decomposed by water, chloral hydrate being 
dissolved and camphor precipitated. 

Chloral-glycerite is prepared by dissolving i drachm (4.0 Gm.) of Chloral in 4 
drachms (15.0 Cc.) of Glycerin, being used as a solvent for powerful alkaloids. 

Chloral -phenol. — Prepared by triturating equal parts of Chloral and Carbolic Acid. 
It occurs as a colorless, viscid liquid, with a sweet caustic taste. Used externally. 

Allied Compounds. 

Amylene Hydrate. — A tertiary alcohol, the chemical name being dimethylethyl- 
carbinol. 

Description and Properties. — It occurs as a limpid, colorless, neutral fluid, of a 



HYPNOTICS. 413 

peculiar odor and burning taste. It is soluble in 8 parts of water, and miscible in all 
proportions with alcohol, chloroform, benzm, glycerin, and fixed oils. 

Dose. — 1-2 fluidrachms (4.0-8.0 Cc). 

Chloral-ammonium. — Obtained by passing a rapid current of dry Ammonia 
through a solution of Anhydrous Chloral and Chloroform as long as it is absorbed. Its 
chemical name is tHchloramidethylic alcohol. It occurs as small, white acicular crys- 
tals, and is soluble in alcohol and slightly soluble in water, although the aqueous solution 
is unstable. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Chloralose. — Prepared by heating equal quantities of Anhydrous Chloral and dry 
Glucose ; hence the name, chloral-ose. 

Description and Properties. — It occurs in the form of fine needles, completely vola- 
tilizing without decomposition. It has an acrid, nauseous taste, and is soluble in hot 
water and in alcohol. 

Dose. — 2-10 grains (0,12-0.6 Gm.). 

Hypnal. — A compound of Chloral and Antipyrine, known as monochlorantipyrine. 
A similar preparation containing more chloral is called dichloralantipyrine . 

Description and Properties. — It occurs in the form of transparent, rhombic crystals, 
odorless and tasteless, soluble in from 5 to 6 parts of water. 

Dose. — 5-20 grains (0.35-1.3 Gm.). 

Hypnone. — A term given by Dujardin-Beaumetz to a member of the ketones, 
known as acetophenone or phenyhnethyl-ketone, phenotnetkyl-acetone. 

Description and Properties. — A colorless, mobile, refrangent liquid, of a pungent 
taste and a persistent odor resembling that of bitter almond and orange. It is not 
inflammable, though mtensifying the combustion of substances impregnated with it. It 
is freely soluble in alcohol, ether, chloroform, benzin, and fixed oils, sparingly soluble 
in glycerin, and insoluble in water. 

Dose. — 5-10 minims (0.3-0.6 Cc). 

Unofficial Preparations. — A Syrup and an Ehxir of Hypnone are in use. 

Ural — Chloral-urethane — Uralium. — A compound of the following drug, Ure- 
thane, and Chloral Hydrate. 

Description and Properties. — A crystalline body, soluble in alcohol and ether, in- 
soluble in cold water, and decomposed by boiling water. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Urethane — Ethyl Carbamate — Ethyl Urethane. — This substance is obtained 
by the action of Ammonia on Ethyl Carbonate, or by that of Urea or Carbamide on 
Ethyl Alcohol at a high temperature. 

Description and Properties. — It occurs as colorless, odorless, columnar or tabular 
crystals, having a pleasant, cooling, and saline taste, somewhat resembling that of salt- 
petre. It is soluble in about I part of water, and in like proportion in ether and chlo- 
roform, in 0.6 part of alcohol, 0.8 part of liquefied carbohc acid, 3 parts of glycerin, 15 
parts of castor oil, and 20 parts of olive oil. 

Dose. — 10-45 grains (0.6-3.0 Gm.). 

Cannabin Tannate and Hyoscine Hydrobromate are both quite powerful 
hypnotics, to be described under Cannabis Indica and Hyoscyamus, respectively. 

The action and therapeutics of the above allied compounds will be compared with 
those of chloral hereafter. 

Antag-onists and Incompatibles. — Chloral is incompatible with 
all alkalies, and calcic hydrate converts it into formate of calcium 
and chloroform. 



414 A TEXT-BOOK OF MATERIA MEDICA. 

Liebreich considers strychnine an antagonist to chloral. But 
from the fact that the principal action of strychnine is upon the 
reflex centers in the spinal cord, its efficacy in opposing chloral 
is certainly inferior to that of chloral as an opponent to strych- 
nine. Atropine is undoubtedly a stronger antagonist in counter- 
acting the depressing influence of chloral upon the heart and 
respiration, as well as upon the spine. External heat is also an 
opponent. 

Synergists. — All the hypnotics favor its characteristic property 
of producing sleep. Morphine enhances its hypnotic effects, while 
lessening its depressing influence upon the heart. 

Physiological Action. — Externally a7id Locally. — Chloral is 
antiseptic, anesthetic, and vesicant It produces redness and some- 
times vesication when applied to the unbroken skin, and when 
strong solutions are brought in contact with the derma or with 
wounds they may even occasion sloughing, and in healthy mucous 
membranes excite much pain. When introduced into the system 
hypodermically chloral is apt to occasion gangrenous inflammation. 

Internally. — Digestive System. — Small doses are slightly seda- 
tive to the stomach, though causing a sense of burning in the 
throat and exciting more or less salivation. Large doses some- 
times produce nausea, vomiting, and purging. 

Circulatory System. — Full medicinal doses may at first accel- 
erate the pulse, which soon, however, becomes slower, weaker, and 
softer. Under toxic doses the heart's action may be weak, rapid, 
and irregular, when death ensues, the heart being arrested in 
diastole. 

A primary effect of chloral is to lower arterial tension by its 
depressant action upon the heart through its nervous mechanism. 
It acts similarly upon the vaso-motor center and upon the struct- 
ures in the arteriole wall, dilating the blood-vessels. 

The fluidity of the blood is increased by the action of chloral, 
and under large doses the red corpuscles are crenated and there is 
a tendency to destroy the white corpuscles. 

Nervous System. — Medicinal doses sometimes occasion a pre- 
liminary stage of cerebral excitement, due probably to a combined 
temporary stimulation of the circulation and of the brain-tissue 
itself This is soon followed — usually in from fifteen to thirty 
minutes — by a sound, dreamless slumber, induced by a direct 
depression of the cortical cells of the psychic areas and an anemic 
condition of the brain. 



HYPNOTICS. 415 

The sleep thus produced is perhaps nearer that of physiological 
slumber than any caused by other agencies, lasting from seven to 
eight hours, when the patient awakes refreshed and without malaise 
or digestive disturbance. 

As upon the circulation and the brain, so upon the nerve- 
centers, there is usually a preliminary stage of excitement, with 
exaggerated reflexes. This condition is, however, of short dura- 
tion, and is succeeded by a greatly diminished reflex irritability of 
the spinal cord and total abolition of reflexes if toxic doses have 
been taken. This action upon the spinal cord is due to the depres- 
sion of its reflex centers, as well as of the sensory centers in the 
nervous system. 

Respiratory System. — In full doses chloral is a respiratory 
depressant, rendering the breathing slower and weaker, while 
under toxic doses it may cease altogether from paralysis of the 
respiratory center. Death may result from this action or from 
paralysis of the cardiac motor ganglia. 

Absorption and Elimination. — Chloral is quite rapidly absorbed, 
and is supposed to circulate in the blood in its original state. It is 
eliminated by the lungs and skin, but chiefly by the kidneys, where 
it reappears as urochloralic acid, which consists of trichlor-ethyl 
alcohol combined with glycuronic acid, although when an exces- 
sive amount of the drug has been taken it may be found in the 
urine unchanged. It usually increases the flow of urine, which 
gives a reaction for sugar with Fehling's test. 

Temperature. — Chloral is a decided antipyretic even in medicinal 
doses, while toxic doses produce a dangerous reduction of tempera- 
ture. This action is doubtless owing to a diminution of heat-pro- 
duction by limiting oxidation in the cells of the body and increasing 
heat-dissipation by cooling the blood in the dilated cutaneous 
vessels and by surface evaporation. 

Eye. — The continued use of chloral almost invariably results in 
a contracted pupil, unless psychic alterations supervene, when the 
pupillaiy contraction gives place to dilatation. This action of 
chloral is due to paresis of the sympathetic nerves supplying the 
iris. Berger claims that when mydriasis is present there is usually 
a congestion of the papilla, resulting from distention of the retinal 
veins ; while, according to Ulrich, intraocular tension is lessened 
in the later stages of chloralism. 

Untozuard Action. — There may occur great anxiety; disturb- 
ances of respiration, such as spasmodic breathing and even as- 



4l6 A TEXT-BOOK OF MATERIA MEDICA. 

phyxia, together with disturbances of vision and swelling of the 
conjunctivae. There may also be present edema of the epiglottis^ 
icterus, and various cutaneous eruptions commonly designated as 
"chloral rash." 

Poisoning. — Although one of the most powerful hypnotics 
known, extraordinary doses of chloral have failed to prove fatal, 
as many as 460 grains (29.8 Gm.) having been given without per- 
ceptible discomfort. Nevertheless, 20 grains (1.29 Gm.), an ordi- 
nary dose, have been followed by toxic effects, while 30 grains 
(1.94 Gm.) have produced death. In view of so uncertain a power 
great care is requisite in the administration of this drug. In many 
ways its action is occult, nor have careful autopsies of fatal cases 
furnished insight into the precise causes of collapse, however clearly 
certain physiological effects may be defined. 

The toxicology of chloral may be classed under two general 
heads — acute and chronic poisoning. In each of these the symp- 
toms are sufficiently marked to indicate a corresponding treatment^ 
although the doubtful action of chloral hydrate has caused it to 
become the subject of special study and a more careful method of 
administration than formerly. 

Acute Poisoning. — Owing to the peculiar action of chloral, the 
symptoms of poisoning from lethal doses are those characterizing 
profound coma. The pulse is feeble, thready, and irregular ; the 
temperature falls rapidly ; there is a striking diminution in the fre- 
quency of respiration, with accompanying lividity ; the skin, par- 
ticularly that of the forehead and extremities, is covered with cold 
sweat ; the pupil contracts and then dilates perceptibly, and great 
muscular relaxation occurs, together with abolition of reflexes,, 
until finally the cerebral functions are suspended and death ensues,, 
caused by paralysis of the respiratory center, the arrest of the 
heart's action taking place in diastole. Autopsies have revealed 
cerebral and pulmonary congestion, together with enlargement of 
the right cardiac cavities. Since chloral but slightly affects the 
motor nerves, and has little influence in impairing muscular con- 
tractility, it appears that the paralytic phenomena attending col- 
lapse are due chiefly to the direct action of the drug upon the 
nerve-centers. 

Treatment of Poisoning. — It is of primary importance to main- 
tain or restore the temperature by means of artificial heat — warm 
blankets, hot bottles, friction, massage, or other resources at com- 
mand. (It has been found that animals are much less susceptible 



HYPNOTICS. 417 

to chloral-poisoning when their temperatures are sustained by out- 
ward appliances than when exposed.) 

Somnolence is to be resisted by such resources as flagellation, 
friction, douches, beating with wet towels, by injection of strong 
hot coffee in the rectum, or any other means readily available. It 
must be borne in mind, however, that the toxic effects of chloral, 
unlike those of opium, tend to reduce cardiac activity, the patient 
often dying simply from exhaustion ; so that violent exercise, such 
as brisk walking, is to be discouraged as a restorative. 

In order to arrest respiratory failure and stimulate the circula- 
tion, hypodermic injections of strychnine or atropine or the admin- 
istration of other physiological antidotes, the inhalation of oxygen, 
and artificial respiration, may prove advantageous. Galvanism,, 
internal stimulants, digitalis, and carbonate of ammonium have 
also been tried, with beneficial results. 

Chro7iic Poisoning. — Chloral toxemia, or chloralism, is a well- 
recognized development of simple dosage, in which the habitual 
use of the drug becomes as baneful and tyrannical in its operation 
as the opium-habit or confirmed alcoholism. Various symptoms 
mark the degrees of excess, in which the respiratory apparatus, 
the skin, and the entire circulation are severally affected. 

Respiration is embarrassed by the presence of dyspnea, which, 
however slight, is manifested after meals or is stimulated by physi- 
cal exertion. The skin may be subject to erythematous eruption, 
either persistent or temporarily excited by trivial causes. Finally, 
the gravest complications may occur in the circulatory system, 
resulting in high fever, pyemia, and ultimate collapse. 

The line of demarkation between these stages of toxemia can- 
not be infallibly drawn, the general effects of chloralism being 
somewhat dependent upon the temperament and habits of the 
individual. The following symptoms are more or less apparent in 
all cases of chronic poisoning : 

The eyes are brilliant ; the speech is voluble, often uncontrolla- 
ble ; and the manner strangely affected by nervous excitement. As 
the craving for the drug assumes the phase of monomania through 
habitual indulgence, its votary appears to border upon pronounced 
insanity. The eyes become irritable and injected, the manner more 
restless, and the subject is sensible of vacuity in the brain and 
liable to accesses of vertigo. During the daytime a listless stupor 
allied to melancholia is observable ; the appetite is uncertain, often 

entirely wanting, and digestion difficult. These symptoms are 

27 



4l8 A TEXT-BOOK OF MATERIA MEDICA. 

accompanied by profound lassitude and debility of heart-action, 
together with marked anemia, especially of the lower extremities. 
Meanwhile, the hepatic functions are deranged, the secretion of 
bile is deficient, and an increasing weakness of the limbs simulates 
paralysis. The stools are colorless and wanting in biliary elements, 
and the urine is stained with bile and at times albuminous and sac- 
charine. 

At this stage of chloralism the necessity of the drug in order 
to overcome insomnia has grown to be imperative, sleep being in- 
duced only through the agency of the accustomed hypnotic. An 
over-dose may now at any moment produce death in the manner 
above indicated, the cumulative effects of the poison with which 
the system is saturated wholly deranging the vital functions and 
rendering elimination impossible. 

The simplest treatment in these extreme cases is primarily the 
gradual withdrawal of the toxic agent, although delirium tremens 
is recorded as a result of abstention. The diet should be carefully 
regulated with a view to restoring, if possible, the decreased vitality. 
Change of scene, abundant air and exercise, chalybeate tonics, 
calmatives, and nerve-stimulants undoubtedly contribute to re- 
establish functional activity and normal circulation, and occasional 
purgatives may assist in eliminating from the system the noxious 
elements with which it has become chronically affected. 

The following prescription has been suggested as efficacious in 
cases of estabhshed chlorahsm : 

R . Chloralis, ^ij vel iv ; 

Morphinae sulphatis, gr. ij ; 

Syr. lactucarii (Aubergier), f^ijj 

Aquae, q. s. ad f Jiij. 

Sig. — Dessertspoonful in water at lo and up. m., if necessary. 

Therapeutics. — Externally and Locally. — An injection into the 
sac of a 10 per cent, solution of chloral has been highly recom- 
mended by Marc See in the treatment of hydrocele. One ounce of 
this solution is injected, being followed in two or three days by a 
copious effusion, which is soon absorbed. 

The antiseptic properties of chloral are utilized as a wash or 
dressing in cancer of the uterus^ foul idcers, etc. For these purposes 
the strength should be from 5 to lO grains (0.3 to 0.6 Gm.) to i 
ounce (30.0 Cc). Gonorrhea is readily cured in many instances 
by a I per cent, injection of this drug. 

Spohn recommends the continued appHcation of a solution of i 



HYPNOTICS. 419 

drachm (4.0 Gm.) of chloral in 4 drachms (16.0 Cc), each, of 
glycerin and water in cases oi furu7iclc. 

Broinidrosis and hyperidrosis have yielded to local applications 
of from 2 to 5 per cent, aqueous solutions of chloral. 

Sir Morrell Mackenzie successfully employed a pigment com- 
posed of 25 grains (1.6 Gm.) of this drug to i drachm (4.0 Cc.) of 
syrup, as a local application to the throat in diphtheria. 

Camphorated chloral is often an efficient remedy for toothache^ 
and, when mixed with petrolatum or simple ointment in the pro- 
portion of I to 7, makes an excellent application in pruritus and 
other itching diseases where the skin is unbroken. This prepara- 
tion undiluted has been used in neuralgia, painted over the affected 
nerves. 

Cregny employs a 20 per cent, solution of chloral in anal fis- 
sure, and a i per cent, solution is used in cracked nipples. 

Chloral is frequently used to preserve urine for microscopic 
examination, though it should not be added to urine reserved for 
chemical analysis intended to detect the supposed presence of 
sugar. 

Solutions of chloral are used for embalming purposes and the 
preservation of anatomical specimens. 

Internally. — The principal use of chloral internally is to depress 
the psychic mechanism and produce sleep. It is also employed to 
depress the reflexes and motor apparatus, and thereby diminish 
convulsions, and is sometimes useful in lowering the action of the 
sensory mechanism. 

As a hypnotic it is especially valuable in conditions character- 
ized by excessive cerebral activity, such as insoniJiia resulting from 
overwork or worry, and in the wakefulness of many acute diseases 
— typhoid, typhus, and o\h^x fevers, delirium tremens, and puerperal 
mania — it is a remedy of well-known efficacy. Its depressing 
effects should always be guarded against during the active course 
of disease, as well as in delirium tremens where great cardiac 
weakness already exists. The insomnia of convalescence would 
usually indicate its use. Indeed, where no special contraindication 
to its employment exists it is the most satisfactory hypnotic we 
possess. 

On account of its powerful depression upon the motor mechan- 
ism it is a valuable drug in treating the various convidsions and 
spasmodic disorders of childhood, such as chorea, whooping cough, 
laryngismus stridulus, and all infantile convulsions and colic. 



420 A TEXT-BOOK OF MA TERIA MEDICA. 

Even in asthma, tetanus, ureinic convulsions, Jiiccough, and 
strychnine-poisoning chloral has proved an important remedy. 

Certain forms of epilepsy, particularly the nocturnal variety, are 
benefited by this drug, and it has been found useful in angina pec- 
toris, though it should be very cautiously administered in these 
cases if there be reason to suspect valvular disease or degeneration 
of the cardiac muscle. 

The reflex vomiting in pregnancy is sometimes relieved by either 
the internal administration of chloral or by enemas. It has also 
been used to depress the reflexes in sea-sickness. 

Cholera and cholera morbus are often alleviated by the hypo- 
dermic injection of this drug, in lo- or 15-grain (0.6-1.0 Gm.) 
doses. 

Spasmodic jHgidity of the os uteri is greatly reduced by a 
medicinal dose of this remedy, and, while its action on the sensory 
mechanism is feeble, it is nevertheless frequently efficient in modify- 
ing the /^^V?^ ^/<3:<^^r and in quieting the alarm and allaying the 
nervous excitement of the mother. 

There are certain other pains of moderate intensity, especially 
those of neuralgia, which are temporarily more or less relieved by 
chloral. Its anodyne effect, however, is too transient to render 
chloral very popular as an analgesic. 

A combination of morphine and chloral is a very efficient ano- 
dyne and hypnotic in sleeplessness due to pain, which is palliated 
by this combination with less digestive disturbance than if the 
former drug had been used alone, and less cardiac depression than 
if the latter had been the sole remedy, the medicines thus aiding 
each other and serving the twofold purpose of mitigating pain and 
inducing sleep. 

The author desires to recommend here chloral hydrate as an 
antipyretic. As has been previously stated, the hypnotics possess 
many of the characteristics of antipyretics, antiseptics, and anes- 
thetics. 

Chloral possesses to a considerable degree the properties of a 
typical antipyretic. It is antiseptic, somewhat volatile, and readily 
eliminated, and thought by some observers to be changed in the 
system into chloroform and sodium formate, while, if not pushed 
too far, it is not toxic. 

We know that one of the principal actions of chloral is to re- 
duce temperature ; indeed, toxic doses exert so marked an effect 
as to produce death by loss of heat alone. 



HYPNOTICS. 421 

In sthenic fevers chloral is an admirable remedy, not only as an 
antipyretic, but in allaying nervous irritability, restlessness, and 
excessive cardiac action, and, in the opinion of the author, this 
remedy claims far more attention in these cases than it has received. 

Contraindications. — Fatty heart ; marked respiratory weakness, 
whether due to acute or chronic disease of the lungs ; atheromatous 
degeneration of the blood-vessels. Owing to the lessened alka- 
linity of the blood, the action of chloral is so unfavorable in acute 
inflammatory rheumatism as to justify classing this disease under 
the present head. 

The drug should be administered cautiously, the patient being 
uninformed as to its nature in certain nervous diseases, lest he 
acquire the chloral habit. 

Administration. — As is recommended in the case of all drugs, 
only the purest article should be prescribed. Frequently the un- 
toward symptoms of chloral are due more to the impure article 
than to any idiosyncrasy against it. The recrystallized form alone 
should be used, the first dose administered not exceeding from 1 5 
to 20 grains (i.o to 1.2 Gm.), repeated as occasion may demand. 
Ordinarily, a maximum dose should not be given oftener than once 
in forty-eight hours. 

Children bear chloral well, and, as a rule, I grain (0.06 Gm.) 
may be prescribed for each year of the child's age. 

Enemas of chloral may be rendered less irritating by mixing 
the drug with the yolk of an ^g^ and milk. Chloral should always 
be well diluted when given internally, especially when combined 
with sodium or potassium bromide. Its disagreeable taste may be 
partially disguised by mixing the solution with peppermint water 
and elixir or syrup of orange. 

The following differences exist between the action and thera- 
peutics of chloral and those of the various allied compounds men- 
tioned above : 

Amylene Hydrate is considered by many observ^ers to be safer than chloral, while 
its soporific effects are produced sooner, being manifested usually in from five to thirty 
minutes, the awakening being ordinarily prompt and complete. In toxic doses it para- 
lyzes the respiratory and cardiac centers. 

Its comparison with chloral is so well stated by Laves that his remarks are here quoted 
verbatim. " It has," he says, " neither the unpleasant and persistent taste and smell of 
the latter (chloral), nor the same uncertainty of action. It seems to have about half the 
strength of chloral, and, although its hypnotic action is perhaps less certain, the sleep it 
causes is more refreshing and the mind remains clearer after its use." 

Amylene hydrate is best given in a mixture of wine and syrup of liquorice; if 
administered by the rectum, it should be suspended in mucilage. 



422 A TEXT-BOOK OF MATERIA MEDICA. 

Chlor-amm5niuni is not so depressing upon the heait and circulation, yet it does 
not offer sufficient advantages over ciiloral to justify its use as a substitute. 

Chloralose. — Its taste is to many persons more nauseating than that of chloral, 
while its action is practically identical, though perhaps not so depressing upon the spinal 
cord, its influence being exerted rather upon the brain. It probably also possesses more 
anodyne properties, and would therefore be superior to chloral as a hypnotic in insomnia 
with pain, sleep being produced in about half an hour. 

Chloralose is best administered in capsules followed by a drink of water, to prevent 
too great irritation of the mucous membranes of the stomach. 

Hypnal. — This substance possesses more antispasmodic properties than chloral, and 
theoretically it should be a better analgesic, it being a compound of chloral and anti- 
pyrine. Yet physicians who have had the largest experience with the drug claim its 
effects to be illusory, and that it has no special value as an anodyne. Indeed, Dujardin- 
Beaumetz, who introduced the drug, regarded it more of a soporific than anodyne. 

Hypnal causes greater gastric disturbance than chloral, and, withal, cannot be recom- 
mended as an efficient substitute for it. 

It may be dissolved in almond oil and given in capsules, or administered in a mixture 
of wine and cordial or some aromatic syrup. 

Hypnone. — As a hypnotic a much weaker substance than chloral, although it has 
found some advocates as a remedy for the insomnia of alcoholism. Toxic doses para- 
lyze the heart and respiration. It should be given in capsules. 

Ural — Chloral -urethane. — A good hypnotic, yet possessing no special advantages. 
It is not so depressing upon the circulation, but is a more feeble antipyretic than chloral. 

Urethane. — Its physiological action is almost identical with that of chloral. It is 
less depressing upon the circulation and respiration, but more so upon the peripheral ends 
of the motor nerves. Acting directly upon the cerebrum, it produces a refreshing and 
dreamless sleep, with no unpleasant after-effects. Nevertheless, it is not so reliable a 
hypnotic as chloral, and its usefulness as a therapeutic agent is still a debatable question, 
probably no hypnotic having been introduced concerning the effects of which there is 
such diversity of opinion. Until, therefore, its use shall be restricted to a place uni- 
versally assigned to it, there can be no good reason why urethane should supplant chloral 
for any purpose. 

It may be given in capsules or in some pleasant water or syrup, and may also be 
conveniently administered as an injection by the rectum. 



Chloral Formamidatum— Chloralis Formamidati— 
Chloral Formamide. 

(Chloralamide.) 

Origin. — Obtained as the result of the interaction between An- 
hydrous Chloral and Formamide, consisting of Chloral Anhydride 
2 parts and Formamide i part. 

Description and Properties. — Chloralamide occurs as white, 
shining, odorless crystals, having a faintly bitter taste. It is solu- 
ble in 9 parts of water and in \\ parts of alcohol. 

Dose. — 10-30 grains (0.65-2.0 Gm.). 

Antagonists and Incompatibles. — It is decomposed into chloral 
with alkalies and with water at above 140"^ F. 



HYPNOTICS. 423 

Synergists. — The bromides of sodium and potassium. 

Physiolog'ical Action. — As might be expected, when the stim- 
ulating action of ammonia is combined with the soporific action of 
chloral, as is the case in chloralamide, we have a substance much 
less depressant upon the heart and respiration than chloral, although 
probably possessing as active hypnotic properties. Its action upon 
different systems compared with that of chloral is as follows : 

Externally and Locally. — It is not so irritating to mucous mem- 
branes as chloral. 

Internally. — Digestive System. — In its action it does not differ 
essentially from chloral. 

Circulatory System. — Its influence is very feeble, producing no 
perceptible effect upon the pulse in medicinal doses. 

Nervous System. — It probably acts as powerfully upon the cere- 
bral cortex as chloral, but in medicinal doses does not depress the 
spinal cord to the same extent, though toxic doses may abolish the 
reflexes and the conductivity of the motor nerves. It produces, 
usually in from thirty minutes to one hour after its ingestion, a sleep 
which lasts from six to ten hours, with no bad after-effects. As an 
analgesic it is superior to chloral. 

Respiratory System. — It is an active respiratory stimulant in 
medicinal doses, through its influence upon the center. Toxic 
doses, on the other hand, paralyze the respiratory center. 

Absorption and Elimination. — In the blood it is converted into 
chloral and formamide, being chiefly eliminated with the urine, 
which it tends to diminish — as well as the amount of phosphates 
excreted — though it is said that the urea is increased by small and 
lessened by large doses. 

Temperature. — In medicinal doses the temperature is uninflu- 
enced. 

Untozvard Action. — Restlessness, mild delirium, rapid and feeble 
heart, great thirst, nausea, and vomiting. 

Poisoning. — Its toxic effects are similar to those of acute chloral- 
poisoning. It does not possess the cumulative action of the latter 
drug nor any tendency to induce chloralism. 

Treatment of Poisoning.— ~T\\q same as for acute chloral-pois- 
oning. 

Therapeutics. — It is not employed externally and locally. Its 
therapeutic uses are similar to those of chloral. As a hypnotic it 
is superior when there is cardiac or respiratory weakness. In the 
insomnia of jieurasthenia it is especially valuable, and, in conjunction 



424 A TEXT- BOOK OF MATERIA MEDIC A. 

with potassium bromide, is preferable to a like combination with 
chloral in cases of sea-sickness. 

By many physicians it is thought to relieve pain better than 
chloral, which, if true, would render it superior in insomnia com- 
plicated with pain. 

Administration. — It is best given in aromatic elixir or some 
other dilute alcoholic vehicle. Simple syrup sHghtly acidulated 
with hydrochloric acid, beer, and sweet wine are also recommended 
as pleasant menstrua. When given at night for insomnia the medi- 
cine should be taken upon an empty stomach, about one hour 
before sleeping-time. 



Chloral Butylicum— Chloralis Butylici— Butyl- 
chloral Hydrate. 

(Croton-chloral.) 

Origin. — Prepared by passing dry Chlorine Gas into Acetic 
Aldehyde, resulting in the formation of butyl-chloral, which is 
separated by fractional distillation, and Water added. 

Description and Properties. — Butyl-chloral occurs as a heavy, 
colorless oil, having an odor resembling that of chloral. The 
hydrate (croton-chloral hydrate) used in medicine is in the form of 
white scales, of a silky luster, nauseous taste, and a peculiar fruit- 
like odor. It is freely soluble in alcohol, ether, glycerin, and hot 
water, but not easily soluble in cold water. Its solutions are un- 
stable, and are decomposed if kept on hand even for a short time. 

Dose. — 3-20 grains (0.18- 1.2 Gm.). 

Incompatibles and Synergists are the same as for chloral. 

Its Physiological Action and Therapeutics are quite similar to 
those of chloral, though it is considered less depressing to the 
heart and circulation, while possessing greater anodyne properties, 
having a selective action upon the fifth nerve, doses even of 2 
grains (0.12 Gm.) often producing anesthesia of the trigeminal 
nerve before other actions of the drug are manifest. 

It is therefore superior to chloral as an anodyne and hypnotic 
in headaches^ facial neuralgia, tic doidoiireiix, viigraine, etc. 

As a simple hypnotic it is feebler and more uncertain in its 
effects than chloral, and, even with its alleged advantages, it is 
doubtful if it will ever supplant that drug to any extent, save in 
cases of neuralgia of the fifth nerve and painfd spasm of the 
.face. 



HYPNOTICS. 425 

In facial neuralgias a mixture of butyl-chloral and tincture of 
camphor may be applied locally. 

Contraindications. — Hyperemia of the brain, gastro-intestinal 
irritation, and weak heart. 

Administration. — It should be given in pill form or in capsules. 
If given in solution, the bitter taste may be disguised by dissolv- 
ing it in the aromatic elixir or syrup of liquorice. A mixture of 
glycerin, syrup, and peppermint water also serves as a good vehicle. 



Sulphonal— Sulphonal— Sulphonal. 

The chemical name of this drug is diethyl-sulphon-dimethyl- 
methane. 

Origin. — It is prepared by combining Ethyl Hydrosulphide 
(Mercaptan) with Acetone, forming mercaptol, which is oxidized by 
potassium permanganate into sulphonal. 

Description and Properties. — It occurs as colorless, odorless, 
nearly tasteless prismatic crystals ; soluble in 450 parts of cold 
water, in 15 parts of boihng water, and in 65 parts of cold or 2 
parts of boiling alcohol. It is a very stable substance, being un- 
affected by concentrated acids or alkalies. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Allied Coinpounds. 

Trional (Diethyl-sulphon-methyl-ethyl-methane). — Origin. — Prepared ex- 
actly like sulphonal, except that Methyl-ethyl-ketone is used in place of Acetone. 

Description and Properties. — Shining, colorless, odorless, crystalline plates ; freely 
soluble in alcohol, and soluble in 320 parts of water. 

Dose. — 10-40 grains (0.6-2.5 Gm.). 

TStronal (Diethyl-sulphon-diethyl-methane). — Origin. — This substance is 
also prepared like sulphonal, differing from the latter in that it contains two additional 
ethyl groups. 

Description and Properties. — Colorless, shining plates and laminae, of bitter taste 
and slightly camphoraceous odor ; soluble in 450 parts of cold and in 5 parts of boiling 
alcohol ; insoluble in water. 

Dose. — 10-40 gi-ains (0.6-2.5 Gm.). 

Antagonists and Incompatibles. — There are none of import- 
ance, and, owing to its insolubility, sulphonal is usually given alone. 

Synergists. — Morphine intensifies its hypnotic action. 

Physiological Action. — Externally and Locally, sulphonal has 
no influence. 

Internally. — Digestive System. — In medicinal doses it has no 



426 A TEXT-BOOK OF MA TERIA MEDICA. 

effect on the digestive tract. Toxic doses may result in nausea^ 
vomiting, and gastric pain. 

Circulatory System. — It has no depressing action on the heart ; 
on the contrary, it is stated by Shick to accelerate the pulse and 
sHghtly raise arterial tension. 

Nervous System. — Like chloral, it depresses the cerebral cortex^ 
but has no influence upon the motor or sensory nerves. Shick 
believes that it stimulates Setschenow's reflex inhibitory centers, 
and to this influence is due the diminished reflex activity occa- 
sioned by the drug. 

It is capable of producing sleep, but its action is very much 
slower than that of chloral, from three to eight hours often elapsing 
between the ingestion of a medicinal dose and its soporific effect, 
the duration of which averages about seven hours. The mental 
disturbance which ensues is greater than in the case of chloral. 
Sulphonal possesses no anodyne properties. 

Respiratory System. — In medicinal doses it is much less depress- 
ing to the respiratory center than chloral, yet when death from 
sulphonal occurs it is usually the result of respiratory paralysis. 

Absorption and Elimination. — Kast alleges that it is slowly sol- 
uble in the gastric juice and gradually absorbed. William J. Smith 
of London, who has experimented extensively with this drug, 
claims that it is eliminated by the kidneys as ethyl-sulphonic acid. 
It has also been shown that under the administration of large doses 
or prolonged use a small quantity of sulphonal is eliminated as 
such unchanged. Furst states that the greater portion is excreted 
in the form of soluble sulphates, and that the urine often contains 
traces of albumin and renal elements, wisely suggesting that the 
drug be at once discontinued should there be reason to suspect 
the presence of hematoporphyrin, as indicated by the discoloration 
of the urine. 

Temperature is unaffected by medicinal doses. 

Eye. — Knaggs and Dillingham report cases accompanied by 
affection of the eye, loss of sensation in the conjunctivae, and ptosis 
lasting two weeks. The cause in these instances was sulphonal- 
poisoning. Medicinal doses produce no notable effect upon this 
organ. 

The Untoward Action and Poisoning resulting from the use of 
sulphonal present symptoms of so varied a character that the drug 
seems to possess no properties of a uniformly toxic nature. More- 
over, in the cases of poisoning recorded the condition of the patient 



HYPNOTICS. 427 

and the quality of the drug have been such as to require c-oniider- 
able variation in the amount given. In one case 30 grains (2.0 Gm.) 
produced death in forty hours {Med. News, Iv. p. 166), while in 
another a man swallowed 3 ounces (96.0 Gm.) of sulphonal, which, 
although resulting in a condition of coma lasting six days, termi- 
nated in recovery {Journ. Ainer. Med. Assn., iv. p. 21). 

Perhaps the most prominent symptoms of acute sulphonal-poi- 
soning are painful convulsions, vomiting, constipation or diarrhea, 
and diminished urine, containing bile, blood, and epithelial casts. 
" Sulphonalism," or chronic poisoning, produces vertigo, head- 
ache, somnolence, mental and muscular debility, edema of the eye- 
lids, cyanosis, and many other deranged conditions of the system. 

Treatment of Poisoning. — Discontinuance of the drug ; elimina- 
tive and symptomatic treatment. 

Therapeutics. — Sulphonal is never used externally, and inter- 
nally it is valuable only as a hypnotic — in insomnia unaccompanied 
by pain, and particularly to produce sleep and quiet the intense ex- 
citemeitt of the insane. In the author's opinion, its many disadvan- 
tages, together with its unreliability and uncertainty of action, 
should relegate it to a place greatly inferior to that of chloral or 
any other hypnotic mentioned above. No skilled and conservative 
physician can peruse the literature of sulphonal without being 
startled by the incongruous statements contained therein, being 
tempted to attribute the irrational statements concerning not only 
this drug, but other new synthetical remedies, to the ill-advised 
efforts ^of some sensational physicians, alike inexact and illogical, 
to advertise themselves rather than give expression to established, 
incontrovertible facts. 

Contraindications. — None of importance. 

Administration. — Sulphonal should be given in powder or cap- 
sules or in hot whiskey. Owing to its insolubility, it should not 
be administered in the form of compressed tablets. 

Paraldehydum—Paraldehydi— Paraldehyde. 

17. ;S^. IP. 

Origin. — A polymeric form of Ethylic Aldehyde. 

Description and Properties. — A colorless, transparent Hquid, 
having a strong, characteristic, but not unpleasant, pungent odor, 
somewhat resembling that of chloroform, and a burning, cooling 
taste. Soluble in 8.5 parts of water and in 16.5 parts of hot water, 
being, as will be observed, more soluble in the former than in the 



428 A TEXT-BOOK OF MATERIA MEDICA. 

latter. Miscible in all proportions with alcohol, ether, and fixed 
and volatile oils. 

Dose. — \-\ fluidrachm (1.0-4.0 Co.). 

Unofficial Preparation. 

EHxir Paraldehydi — Elixir Paraldehydi — Elixir of Paraldehyde. — Dose, i- 
2 fluidrachms (4.0-8.0 Cc). 

Synergists. — Opium and the hypnotics aid its action. 

Physiolog'ical Action. — Externally ajid Locally. — Antiseptic, 
antifermentative. 

Internally. — Digestive System. — Paraldehyde has no action upon 
the digestive tract. 

Circulatory System. — It differs from chloral in affecting the cir- 
culatory system favorably in medicinal doses, tending rather to 
slow and strengthen the pulse. Toxic doses weaken the heart and 
lower arterial pressure, the heart's action ceasing in diastole. 

Nervous System. — Its influence upon the brain and spinal cord 
is similar to that of chloral. The sleep it induces, however, is not 
so prolonged as that caused by the latter drug, more frequent doses 
being required for continued soporific effects. The sequelae of 
paraldehyde are not unpleasant. 

Respiratory System. — Its action resembles that of chloral, al- 
though it is not so powerful a respiratory depressant In toxic 
doses death usually ensues from paralysis of the respiratory center. 

Absorption and Elimination. — Paraldehyde is eliminated by the 
lungs and kidneys. 

Temperature. — Like chloral, it lowers the temperature, but in 
less degree. 

Untoward Action. — It occasionally causes irritation of the 
mucous membranes and erythematous eruption. 

Poisoning. — The symptoms of poisoning are similar to those of 
chloral. Fatty degeneration of the heart and liver have been found, 
together with disorganization of the red corpuscles. 

Treatment of Poisoiiing. — The same as in poisoning from chloral. 

Therapeutics. — Like those of chloral. Paraldehyde is more 
hypnotic than anodyne, appearing to be best adapted to relieve so- 
called idiopathic insomnia. It is a better diuretic than chloral, and 
in certain degenerated conditions of the heart and arteries, where a 
diuretic as well as hypnotic is desirable, paraldehyde serves as a 
valuable remedy. 



NARCOTICS. 429 

Cervello has recommended it highly in strycJmine-poisoningy 
and several cases of its successful use in tctaims are reported. 

Administration. — It may be given in capsules, or, when other- 
wise administered, its unpleasant taste may be disguised by giving 
it in an emulsion flavored with orange or bitter almond. Glycerin 
also renders it quite palatable, yet it is always more disagreeable to 
the taste than chloral, besides lending to the breath an offensive 
and persistent odor. 



GROUP v.— NARCOTICS. 

Opium— Opii— Opium. L.S.JP. 

Origin. — The concrete, milky exudation obtained by incising 
the unripe capsules of Papaver soninifej'inn (L.), the substance in 
its normal moist condition yielding not less than 9 per cent, of 
crystaUized morphine when assayed. 

The poppy from which opium is derived is indigenous in West- 
ern Asia and cultivated in Egypt, Persia, Asia Minor, the elevated 
plains of India, and in some parts of Europe. 

Description and Properties. — Opium appears in irregular or 
subglobular cakes — with the remnants of poppy-leaves and the 
fruit of a species of Rumex adhering to their surfaces — plastic or 
of a harder consistence, chestnut-brown or darker, and somewhat 
shining internally, showing tears, and fragments of vegetable tissue. 
It has a sharp, narcotic odor and a peculiar, bitter taste. This de- 
scription applies to the Smyrna, Levant, Turkey, and Constantinople 
opium. There are, however, five other varieties — viz. i. Egyptian, 
flattened, roundish cakes ; 2. Persian, black, cylindrical sticks, or 
small cakes or balls, wrapped in paper ; 3. Indian, flat squares 
covered with mica and wax or an oiled paper wrapper ; 4. Chinese, 
oblate-spheroidal masses wrapped in white paper ; 5. European. 

Opium contains about twenty different alkaloids, either in a 
free state or in combination with some acids. The principal alka- 
loids, in the order of their medical importance, are morphine, 
codeine, nmxeine, and tliebaine ; others are narcotine, papaverine, 
cryptopine^ psendonwrpJiine, protopine, Jiydrocotarnine, laiidanine, 
cadamine, rheadine, meconidine, laiidanosine , lanthopine , gnoscopine, 
and oxynarcotine. 

The following constituents of opium are in some respects im- 
portant : Meconic acid, mecoiiin, ineconoiosin, and porpliyroxin. 



430 A TEXT-BOOK OF MATERIA MEDIC A. 

In addition to the above, opium contains these substances, 
making it one of the most complex drugs in Materia Medica: 
Mucilage, resin, fats, essential oil, glucose, caoutchouc, ammo7tium, 
calcium, and magnesium salts, and odorous and coloriiig matters, 
besides certain impurities and adulterants, such as stones, fruits, 
leaves, starch, water, lead, etc. 

Dose. — 1-2 grains (0.015-0. 12 Gm.). 

Official Preparations. 

Opii Piilvis — Opii Ptilveris — Powdered Opium. — Dose, }(-2 grains (0.015- 
0.12 Gm.). 

Powdered opium should yield not less than 13 nor more than 15 per cent, of crys- 
tallized morphine. 

Acetum Opii (10 per cent.) — Aceti Opii — Vinegar of Opium. — Dose, 3-15 
minims (0.18-1.0 Cc). 

ExtrSctum Opii (18 per cent, of morphine) — Extr^cti Opii— Extract of Opium. 
— Dose, i-l grain (0.01-0.06 Gm.). 

EmplSstrum Opii (6 per cent, of extract of opium) — Empl^strum (ace.) Opii — 
Opium Plaster. — For external use. 

Formula: Extract of Opium, 60; Burgundy Pitch, 180 ; Lead Plaster, 780; 
Water, 80. 

Opium Deodoratum (13 to 15 per cent, of morphine) — Opii Deodorati — De- 
odorized Opium (Denarcotized Opium). — Dose, |-2 grains (0.0 15-0. 12 Gm.). 

Pilulse Opii (i grain, or 0.06 Gm., in each pill) — Pilulas (ace.) Opii — Pills of 
Opium. — Dose, i or 2 pills. 

Piilvis IpecacuSnhae et Opii — Ptilveris Ipecacuanhae et Opii — Powder of 
Ipecac and Opium (Dover's Powder). — Dose, 5-10 grains (0.3-0.6 Gm.), 

Formula: I grain (0.06 Gm.) Opium, I grain (0.06 Gm.) Ipecac, 8 grains (0.5 Gm.) 
Sugar of Milk, in every 10 grains (0.6 Gm.). 

Tinctura Opii (10 per cent.) — Tincturae Opii — Tincture of Opium (Laudanum). 
— Dose, 5-15 minims (0.3-1.0 Cc). 

13 minims (0.78 Cc.) represent about i grain (0.06 Gm.) of Opium. 

Tinctiira Opii Camphorata — Tincturae Opii Camphoratae — Camphorated 
Tincture of Opium (Paregoric). — Dose, I-4 fluidrachms (2.0-15.0 Cc). 

Formula: Powdered Opium, 4; Benzoic Acid, 4; Camphor, 4; Oil of Anise, 4; 
Glycerin, 40; Diluted Alcohol, to looo. Prepared by maceration and percolation. 
4 fluidrachms (15.0 Cc.) represent about i grain (0.06 Gm.). of Opium. 

Tinctura Opii Deodorati ( 10 per cent.) — Tinctiarae Opii Deodorati — Tincture 
of Deodorized Opium. — Dose, 5-15 minims (0.3-1.0 Cc). 

Tinctura Ipecacu^nhae et Opii — Tincturae IpecacuSnhae et Opii — Tincture 
of Ipecac and Opium (Tincture of Dover's Powder). — Dose, 5-15 minims (0.3- 
i.o Cc). 

10 minims (0.6 Cc.) contain i grain (0.06 Gm.) each of Opium and Ipecac. 

Trochisci Glycyrrhizae et Opii — Trochiscos (ace) Glycyrrhizae et Opii — 
Troches of Liquorice and Opium. — Dose, i to 3 troches. 

Each troche contains about -^^ grain (0.005 Gm.) of Opium. 

Vinum Opii (10 per cent.) — Vini Opii — Wine of Opium. — Dose, 5-15 minims 
(0.3-1.0 Cc). 



NARCOTICS. 431 

The Description and P7-ope7'ties of the official alkaloids of opium and their salts are 
as follows : 

Morphina — Morphinse — Morphine. — Colorless or white, shining, prismatic 
crystals, or fine needles, or a crystalline powder, odorless, having a bitter taste, per- 
manent in the air. Soluble in 4350 parts of water, in 300 parts of alcohol, in 455 parts 
of boihng water, and in 36 parts of boiling alcohol. Dose, \-\ grain (0.008-0.015 
Gm.). 

Morphinae Acetas — Morphlnae Acetatis — Morphine Acetate. — A white or 
faintly yellowish-white, crystalline or amorphous powder, having a faint, acetous odor 
and a bitter taste. Soluble in 2.5 parts of water and in 47.6 parts of alcohol. On pro- 
tracted exposure to the air the salt gradually loses some acetic acid, becoming less 
soluble. It should be kept in dark amber-colored, well-stoppered bottles. Dose, \-\ 
grain (0.008-0.015 Gm.). 

Morphlnae Hydrochldras — Morphinae Hydrochloratis — Morphine Hydro- 
chlorate. — White, feathery needles, of a silky luster, or minute, colorless, cubical 
crystals, odorless, having a bitter taste, permanent in the air. Soluble in 24 parts of 
water and in 62 parts of alcohol. Dose, \-\ grain (0.008-0.015 Gm.). 

Morphinae Stilphas — Morphinae Sulphatis — Morphine Sulphate. — White, 
feathery, acicular crystals, of a silky luster, odorless, of a bitter taste, permanent in air. 
Soluble in 21 parts of water and in 702 parts of alcohol. Dose, \-\ grain (0.008- 
0.015 Gm.). 

Codeina — Codeinae — Codeine. — White or nearly translucent, orthorhombic 
prisms, or octahedral crystals, odorless, having a faintly bitter taste, and slightly efflores- 
cent in warm air. Soluble in 80 parts of water and in 3 parts of alcohol. Dose, |—2 
grains (0.03-0.12 Gm.). 

Various salts of codeine are in use, the sulphate being the most important. 

Official Pi'eparations of Morphine Sulphate. 

Piilvis Morphinae Comp6situs — Ptilveris Morphinae Comp6siti — Com- 
pound Powder of Morphine (Tully's Powder). — Dose, 5-15 grains (^0.3-1.0 Gm.). 

Formula: Morphine Sulphate, i; Camphor, 19; Glycyrrhiza, 20; Precipitated Cal- 
cium Carbonate, 20 ; Alcohol, q. s. to 60. 

Trochisci Morphinae et IpecacuSnhae — Trochiscos (ace.) Morphinae et 
Ipecacu^nhae — Troches of Morphine and Ipecac. — Dose, i to 5 troches. 

Formula: Morphine Sulphate, 0.16; Ipecac, 0.50; Sugar, 65; Oil of Gaultheria, 
0.2 ; Mucilage of Tragacanth, a sufficient quantity to make 100 troches. Each troche 
contains about ^ grain (0.0015 Gm.). 

Antagonists and Incompatibles of Opium and its Alkaloids. 

— The physiological antagonists are atropine, strychnine, coffee or 
caffeine. Quinine antagonizes some of the cerebral effects of the 
drug, while tartrate of antimony and potassa (tartar emetic) and 
digitalis oppose its action on the intracranial circulation. The 
incompatibles are alkalies, tannic acid and infusions containing it, 
and salts of lead, iron, copper, mercury, and zinc. 

The following are incompatible with morphine and its salts : 
iodine and iodides, bromine and bromides, Fowler's solution, 
and sodium borate. 



432 A TEXT-BOOK OF MATERIA MEDICA. 

Synerg-ists. — The hypnotic action of opium is aided by the 
hypnotics ; its anodyne influence is enhanced by belladonna and 
cocaine, and its sudoriferous effects by ipecacuanha. 

The Physiolog-ical Action of opium differs in some respects 
from that of morphine or codeine, and will therefore be described 
first. 

Externally and Locally. — Applied to the unbroken skin, opium 
possesses feeble analgesic properties, and from mucous membranes 
or raw surfaces it is readily absorbed, producing marked anodyne 
effects. 

Internally. — Digestive System. — Its prominent action is upon the 
secretions — checking that from the salivary glands, causing great 
dryness of the mouth and consequent thirst — largely diminishing 
those from the stomach, and reducing the bile and pancreatic juice 
secreted. In fact, every secretion in the body is lessened except 
the perspiration, the cause being the depressing influence of the 
drug upon the secretory centers in the medulla. It may be added 
that the peristaltic movements of the digestive apparatus are re- 
duced, which, together with diminished secretions, impairs diges- 
tion and produces constipation. 

The action upon the intestines, however, varies with the dose 
administered, moderate or full medicinal doses checking peristalsis 
and promoting constipation. On the other hand, very large or very 
small doses increase peristalsis, the former augmenting this effect, 
and producing violent movement of the bowels through the drug's 
paralyzing action upon the splanchnic inhibitory fibers of the intes- 
tine, so that inhibition is removed and peristalsis reinforced. Very 
small doses act as purgatives when by some reflex disturbance, 
such as a tender ovary, the peristalsis is inhibited. Minute quanti- 
ties, by partially benumbing the inhibitory nerves or diverting 
the stimulus from them to the stimulating fibers, relieve consti- 
pation. This action is rendered serviceable in the similar con- 
stipation accompanying lead-poisoning, the metal constipating the 
patient not only by its astringent action, but also by the tetanic 
spasm of the intestines caused by the irritating action of the lead 
upon their mucous membrane. The feces are held by spasmodic 
intestinal contraction, relief of which by a small dose of opium, 
sufficient to induce peristalsis, will be followed by evacuation. 

Circulatory System. — Small doses accelerate the pulse, render- 
ing it fuller and firmer, and dilate the arterioles, though increasing 
arterial tension. This action is due to stimulation of the vaso- 



NARCOTICS. 433 

motor mechanism of the circulatory apparatus. Large doses, while 
primarily quickening, soon retard the heart's action, rendering the 
pulse full. This influence is occasioned by stimulation of both 
ends of the vagus. Should the dose be lethal, the pulse may 
become rapid and weak from over-stimulation, and consequent ex- 
haustion, of the vaso-motor center and pneumogastric nerves. 

Nervous System. — Opium seems to act differently upon the 
brain and the spinal cord. Upon the former it produces a tempo- 
rary period of excitement, varying in duration according to the- 
size of the dose administered, small doses greatly stimulating the 
imaginative faculty. The state of excitation is followed by depres-, 
sion, soon yielding to easily disturbed sleep, frequently disturbed 
by dreams, which may be of a pleasant, voluptuous character or 
disagreeable and hideous, the condition of the patient at this time 
varying with the dose he has taken — all occasioned by removal of 
the inhibition from the reflex centers. If it has been sufficient tQ 
produce profound stupor, the patient is insensible to sound, light,. 
or external irritation. Pain is abolished, and the reflexes transmit 
no impression. On waking the patient complains of headache, a 
feeling of languor, vertigo, nausea, and constipation. 

Opium first stimulates and afterward depresses the higher cen- 
ters, the same action being subsequently manifested in the lower 
centers. 

The cerebral exhilaration is doubtless the result of an increased 
blood-supply to the brain, while the sleep and mental depression 
are due to the direct sedative action of the drug upon the cortical 
cells of the brain. 

Pain is relieved by opium through its depressing influence upon 
the entire sensory apparatus, the peripheral ends of the sensory 
nerves, the conducting path in the spinal cord, and the receiving 
cerebral center all being similarly affected by opium, rendering the 
drug one of the most powerful analgesics known. 

Respiratory System. — In very small doses opium slightly stim- 
ulates respiration ; in full or large doses it is a strong respiratory 
depressant, its action being upon the center in the medulla. Death 
is usually caused by paralysis of respiration. 

Absorptio7i and Elimiiiation. — Opium is rapidly absorbed, and is 
eliminated chiefly by the gastro-intestinal mucous membrane and 
very little by the kidneys. 

Moderate quantities of the drug are oxidized in the body, 
though when large doses are administered opium may be found 

28 



434 A TEXT-BOOK OF MA TERIA MEDICA. 

unchanged in the urine. It is also excreted in the bile, in the 
milk, and to some extent in the sweat, which is largely increased 
by opium, particularly when the drug is combined with ipecacu- 
anha, as in Dover's powder. The sweat is the only secretion aug- 
mented by opium, although the manner in which the sudoriparous 
glands are stimulated is not positively known — whether centrally 
or peripherally. Probably the action is due to increasing venosity 
of the blood stimulating the sweat-centers in the spinal cord. 

The reabsorption of opium may be prevented by frequently 
washing out the stomach, from which viscus the drug is mainly 
eliminated. Catheterization is also indicated from time to time to 
assist elimination. 

Temperature is at first raised, but later lowered when free 
diaphoresis is established. 

Eye. — The pupils are minutely contracted by large doses, the 
modus operandi not being fully understood, though- probably the 
action is due to stimulation of the oculo-motor center. The pupil 
usually dilates just before death from opium-poisoning, owing 
either to paralysis of the oculo-motor center or depression of the 
sympathetic fibers, and, perhaps, excessive venosity of the blood. 
Untoward Action. — Headache, disturbances of hearing, muscular 
tremor or temporary paralysis, itching of the skin with or without 
eruption. In case the latter symptom appears, it is commonly in 
the form of small red spots resembling roseola. An erythematous 
inflammation may affect the mucous membrane of the mouth and 
throat. 

Morphine has produced paresthesia of the sense of taste, as 
well as spasm of accommodation of the eye and edema of the 
eyelids. Many other untoward manifestations occur, even under 
minute doses, in persons having an idiosyncrasy against the drug. 
Poisoning. — Small medicinal doses of opium, as we know, tend 
to produce moderate excitement, a pleasing sense of freedom from 
care, and, in sleep, tranquil, even happy, dreams. Far otherwise it 
is with toxic doses. Under their influence the entire physiological 
conditions of the system are perverted. Here the drug exerts its 
baneful effects, and the mind rapidly succumbs to a power over 
which it has no control. The period of excitement is absent, the 
predominating desire of the patient being to sleep, and from the dull, 
lethargic stupor which supervenes he is roused only by vigorous 
and unremitting treatment. Giddiness portends this mental and 
physical state. The pulse, though still full, diminishes in fre- 



NARCOTICS. 435 

quency; the breathing becomes heavy and labored, and finally 
stertorous ; the heart is now apparently seized with indefinable 
oppression, and the pupils are visibly contracted ; the skin is dry 
and warm, and the face suffused or at length of a marked cyanotic 
hue, cutaneous eruptions being not uncommon. Should relief be 
not forthcoming, the pulse continues to sink ; the drowsiness and 
subsequent lethargy are followed by a state of true coma ; the 
muscular system is wholly relaxed ; the reflexes are obliterated, 
and death ensues from respiratory failure, the asphyxia being 
closely accompanied by cessation of the heart's action. 

Although this stage of toxemia is not necessarily fatal, it will be 
readily seen that its alarming manifestations demand the utmost 
skill and vigilance on the part of the physician. In fact, the diag- 
nosis is not always clear, the phenomena so nearly resembling 
those of alcoholism, especially apoplexy, uremia, and congestion 
of the brain, that it is at times next to impossible to predicate from 
symptoms alone the presence of opium-poisoning. It may be ob- 
served, however, that, save in certain exceptional cases, contraction 
of the pupil is wanting in apoplexy, while there is present partial 
distortion of the face or paralysis of the limbs. From uremia 
opium-poisoning is differentiated by the presence in the former of 
edema and by albumin and casts in the urine. 

The treatment of acute opiwn-poisoning covers an ample field 
of therapeutic experience, the remedies employed being numer- 
ous, and in their physical properties often widely diverse. 
Three objects are of paramount necessity : to evacuate the 
stomach, maintain respiration, and prevent failure of circulation. 
The first of these may be attained by the use of the stomach- 
pump or siphon-tube (easily improvised). Active stimulants and 
irritating emetics are of great service, the latter being assisted 
by frequent and copious draughts of warm water in the intervals 
of vomiting, and the doses being large in order to make an im- 
pression upon the insensibility of the stomach. Various agents, 
including chemical antidotes, may aid recovery — tannic acid, per- 
manganate of potassium, strychnine especially, atropine, strong 
black coffee, hypodermic injections of apomorphine, etc. — and other 
resources have been tried with varying success. Warm water in- 
jected into the rectum and stomach have proved efficacious. Coun- 
ter-irritants, flagellation, shouting in the ear, may rouse the patient 
from his lethargy. Should artificial respiration become necessary, 
either Sylvester's method or the use of the faradic current can be 



436 A TEXT-BOOK OF MATERIA MEDICA. 

adopted. It is here of great importance that the subject should be 
kept awake, that he may voluntarily assist in the recuperative pro- 
cess, which while the will is quiescent in sleep he is unable to do. 
The full force of the faradic battery may be used, but it should 
never be applied to the phrenic nerve directly, lest paralysis of the 
cardiac muscles ensue. Should the bodily temperature fail to be 
sustained, external heat should be employed to supply the de- 
ficiency. 

In maintaining the circulation strychnine and atropine, both 
powerful antidotes to opium, will be of great value. Rubbing, 
massage, flagellation — but never such as to produce exhaustion — 
and, if necessary, moderate venesection, may be used as supple- 
mentary efforts at restoration. Walking the patient will often ward 
off somnolence, the exercise being continued until thorough wake- 
fulness results, provided there be no untoward muscular debility. 
Inhalations of ammonia have proved efficacious, and the use of the 
catheter has been found to stimulate excretion by the kidneys. 
Special efforts should be directed, however, toward sustaining 
respiration, since failure in this respect is most to be feared. 
Should the breathing be normally resumed, or even partially so, 
there is no special danger to be apprehended from the state of 
coma. Cerebral effects have sometimes been relieved by quinine. 
The use of atropine is not to be encouraged, save in exceptional 
cases — and then without repetition — since it may prove irritating to 
the cardiac ganglia, while continued doses are Hable to induce 
belladonna-poisoning, as dangerous as the original condition. 

In the choice of remedies it should be borne in mind that the 
influence of opium is Hmited to the nervous system, and that 
lethal doses tend to cause paresis of the arterioles and veins. 
Each case, moreover, is to be studied individually, scarcely any 
drug being more dependent than opium upon the idiosyncrasies of 
the patient. 

C J ironic opimn- poisonings resulting from the habitual use of 
opium, its most active constituent morphia, or its salts, is undoubt- 
edly one of the most pernicious habits to which the human system 
can be subjected, its mental, moral, and physical phenomena being 
among the saddest and most terrible known to therapeutics. 

The symptoms of this disease of mind and body are in some 
respects similar to those of acute opium-poisoning in their physio- 
logical aspect, but the psychological features of the malady are 
more abhorrent and less amenable to treatment. Extreme nervous- 



NARCOTICS. 437 

ness and tremors ; abnormal exercise of cerebral functions, mani- 
fested in extraordinary hallucinations ; hypochondria ; anxiety ; 
insomnia ; spasms and painful neuralgia ; and not infrequently 
suicidal intent or mania, — these are among the prominent charac- 
teristics which mark the victim of the opium habit. The physio- 
logical symptoms include dryness of the tongue ; vesical irritation, 
with possibly excessive urinary discharge ; constipation ; serious 
disturbances of the sexual function, resulting in impotence or sus- 
pension of catamenia ; while caries of the teeth is also sometimes 
present, — the derangement of the system being wellnigh com- 
plete, often beyond the reach of therapeutic aid. In the words of 
a votary to the habit, '' My head throbs like a trip-hammer ; my 
teeth are set ; a metalHc taste is in my mouth ; my face, neck, and 
arms are red as fire, and all the veins swollen. Worst is the 
throbbing in my head." 

The conditions inducing the opium-habit are frequently caused, 
or are largely influenced, by the therapeutic employment of the 
drug — as was the case with De Quincey, whose graphic analysis 
of the Pleasures and Pains of opium, if possibly to be taken cum 
grano sails, is at once the most powerful and the most eloquent 
ever written. The patient who has once experienced the anodyne 
influence of the drug — as captivating to his senses as though it 
were a draught of fabled Lethe — readily yields to it upon the 
slightest occasion, as, for instance, to alleviate trivial indispositions 
for which, in ordinary circumstances, he would ridicule the idea of 
medical treatment. With repeated indulgence — often promoted by 
a casuistic reasoning of which by degrees the subject is scarcely 
conscious, or by persistent and intentional deception — comes the 
craving which knows no restraint, and which can be quieted only 
by complete mental and physical regeneration or the merciful re- 
lease of death. Dependent for fancied happiness upon his ex- 
traneous resource, the blind idolater of personal ease pursues his 
Ignis /«/z«^.f heedless of consequences, in his mental and moral 
degeneracy apparently lost to all finer feehng or to manlier resist- 
ance in presence of his insidious, blighting temptation. Mean- 
while, physiological torpor demands an ever-increasing amount of 
the drug that the system may be sufficiently impressed. Psychical 
emotions, anxiety, anger, mental anguish, or, indeed, the most 
puerile pretexts, continue to furnish occasion for indulgence, and 
the facilities of administration afforded by the modern method of 
hypodermic injection unhappily serve to stimulate a longing for 



438 A TEXT-BOOK OF MATERIA MEDIC A. 

momentary exhilaration or the alluring oblivion which may oblit- 
erate the past, but which reason cannot suffer to ignore the future 
when the mind recalls the overwhelming testimony of experience. 

Should amelioration be now attempted and the drug withheld, 
more distressing symptoms still are developed. Depression and 
exhaustion are manifested at once, followed by increasing melan- 
cholia, attended by horrible visions and anxieties no mental energy 
— such as remains of it — can dispel. The pulse is scarcely percepti- 
ble ; the patient is in a state of nervous tension, occasionally evinced 
by paroxysms of despair ; and in the deprivation endured the poor 
wretch, with outstretched hands and imploring expression, begs, 
screams, for morphine, laudanum, or other habitual form of opium, 
at last breaking down utterly in a fit of passionate weeping when 
denied the solace craved. It is, indeed, an appalling spectacle of 
human misery which, could it be witnessed by those in whose 
imaginations the first subtle effects of opium awaken dreams of 
elysium, might well persuade the victim to forswear a gratification 
for which so tragic a fate is reserved. 

The treatment of so dire a malady — for such the chronic use 
of opium must be regarded — demands the utmost forethought, 
patience, and tact. The method of sudden, absolute withdrawal 
of the drug is admitted by the wisest observers to be fraught with 
danger commensurate with that of the indulgence to be overcome. 
Collapse, insanity, and other serious results have attended so dras- 
tic a measure, the general opinion obtaining to-day being that a 
gradually reduced dose of the drug is the safest and most rational 
mode of procedure. The conditions are extremely difficult to 
combat successfully, repeated hypodermic injections being eradi- 
cated from the system far less readily than opium from the stom- 
ach. The moral nature of the patient, too, has become so per- 
verted that little or no reliance can be reposed in his veracity, the 
physician being thrown upon his unaided resources, supplemented 
by the untiring vigilance and fidelity of the attendant. 

The gravity of the situation should from the first be fully real- 
ized, since it is too often simply a case of life or death, the patient 
being not infrequently seized with the desire of self-destruction in 
the extremity of mental anguish occasioned by the ordeal imposed 
by unwonted abstinence. Could he be put upon his honor, and 
that honor be steadfast, his co-operation would be invaluable. But 
this assistance is seldom at command, the patient's loyalty of pur- 
pose and unswerving resolution, as professed, being wholly sub- 



NARCOTICS. 439 

servient to a volition long since weakened, if not annihilated, by- 
pitiful sophistries and moral degradation. Nevertheless, the case 
must be approached from the sympathetic side, and every means 
of inspiring confidence employed, remembering that a human will 
as well as body is under treatment, and that mental sanity as well 
as physiological health is to be restored. 

Of the many agents suggested by therapeutic science, valerian- 
ate of ammonia, fluid extract of coca or camellia, judicious tonics, 
easily digested and strengthening food, and, if necessary, alcoholic 
stimulants, have been especially beneficial. Other remedies, such 
as dilute phosphoric acid, tincture of lupulin, codeine, trional, co- 
nium, and cannabis Indica, have in many cases proved efficient 

Change of scene, a healthful, stimulating diet, and abundant 
out-door exercise — always favorable to diversion of thoughts — 
seldom fail to react encouragingly upon the mind and physique of 
the patient. The exhibition of symptomatic remedies not indicated 
has been authoritatively condemned, the primary object of treat- 
ment being not so much to afford temporary relief of pathological 
conditions as to remove the dominating cause. Cocaine has also 
been discouraged, lest its use generate habitual desire for the drug. 
In conclusion, it may be said that the obstacles attending a com- 
plete mastery of the opium habit by means of therapeutic resources 
are apparent from the fact that but a small proportion of patients 
addicted to the use of morphine are permanently cured. Yet, though 
the admission be made with regret, it is no disparagement to pro- 
fessional science nobly directed, and assuredly carries with it a 
fearful warning to those who are tempted to seek immunity 
from mortal ills by purblind indulgence in so fatal a medium of 
relief 

Therapeutics. — In a general way, the medical uses of opium 
are — i, to relieve pain ; 2, to produce sleep ; 3, to lessen reflex irri- 
tation ; 4, to diminish secretion ; 5, to support the system ; 6, to act 
as a sudorific. 

Opium is the most important and useful drug known to medi- 
cine, as well as the most remarkable in its multifarious applications. 
It would, therefore, be idle — indeed, wellnigh impossible — to enu- 
merate all the maladies and abnormal conditions for which this 
invaluable remedy has been employed. It perhaps best represents 
the typical symptom medicine, being used almost invariably for the 
relief of one or more symptoms of disease, rather than for its spe- 
cific or direct curative action upon the disease itself Unless some 



440 A TEXT-BOOK OF MA TERIA MEDICA. 

special contraindication exists, it may be employed when any of the 
above medical uses are desired. 

Externally and Locally. — It is used to relieve pain, either in the 
form of an ointment, a liniment, or a suppository, an aqueous solu- 
tion of morphine sulphate as a collyrium in conjunctivitis, in the 
form of bougies, injections, snuff, or lozenges. Or solution in diseases 
of the genito-urinary tract, the ear, 7tose, and throat. 

Tincture of opium is frequently added to flaxseed poultices to 
allay the pain of superficial inflammation. 

Internally. — Either opium or morphine may be used for the 
relief of pain, regardless of the seat or cause. Pain of moderate 
intensity may often be allayed by other anodynes, such as anti- 
pyrine, exalgin, etc. ; but when it is severe or excruciating, it is 
useless to experiment with other drugs when so potent an agent 
for relief as opium is obtainable. 

It is not recommended for ordinary use to produce sleep, because 
of its seductive, insidious action and the danger of creating in the 
patient a tendency toward the opium habit. When, however, sleep- 
lessness is occasioned by pain, and in the insomnia of delirium 
tremens or acute majtia, opium or some one of its preparations is 
often an indispensable remedy. 

Spasmodic conditions of involuntary muscles, as in cases of 
astlwia, the convulsions of tetarius, uremia, hydrophobia, chorea, etc., 
frequently call for a drug as powerful as opium. 

The paroxysms oi periodical fevers, and especially the congestive 
chills of virulent malaria, often yield more readily to this medicine 
than to quinine. 

In dysentery, cholera morbus, and cholera it has been used with 
excellent results, having also been employed in many cases of 
excessive secretion in other portions of the body. 

Opium is frequently given in bro7ichitis with profuse secre- 
tion and irritable cough, in which condition it acts favorably 
through depression of the reflexes and power to allay irritation 
and check secretion. In these cases, however, small doses only 
should be administered, and the condition of the patient carefully 
watched, especially that of the aged, lest the respirator^' apparatus 
be so depressed that expulsion of the accumulated viscid mucus be 
impossible and danger of death from suffocation ensue. 

As a supporter of the system when the vital forces are weak- 
ened by acute or chronic disease or injury there are but few drugs 
as efficacious as opium. It calms and strengthens the debilitated 



NARCOTICS. 441 

lieart, and secures to the patient refreshing sleep, soothing and in- 
vigorating his system by means of the much-needed rest. If pain 
be persistent, wearing seriously upon the sufferer's vitality, opium 
by its anodyne influence enables him to recuperate during the 
interval of relief 

One of its most valuable services is in peritonitis^ although, not- 
withstanding its incomparable value, some physicians, more scien- 
tific than practical, have subordinated it to the treatment by free 
purgation with saline cathartics or the irrigation of the peritoneal 
cavity with antiseptic solutions in order to eradicate from the sac 
the pathogenic bacteria. 

Despite the aggressiveness and dogmatism of abdominal sur- 
geons, opium still remains, and justly so, the abiding resource of 
the great mass of conscientious physicians, more thoughtful of their 
patients' welfare than of enhancing their skill and technique in 
abdominal surgery. 

When given in proper doses in peritonitis, opium reduces peri- 
stalsis and removes the pain, promoting the patient's comfort and 
supporting his vital powers. It diverts the blood from the con- 
gested peritoneum by dilating the cutaneous blood-vessels. Further- 
more, it possesses the pecuHar property of causing the irritation in 
the inflamed area to contract reflexly the local blood-vessels, thus 
diminishing the blood-supply to the diseased part. 

In shock from severe injury, opium, by benumbing sensation 
and depressing the reflex mechanism, lessens the danger of cardiac 
and respiratory failure. 

In pleurisy it is the most efficient remedy, reHeving congestion 
as in peritonitis, besides reducing the respirations, and consequently 
the friction of the inflamed pleural surfaces, as well as allaying the 
pain accompanying each respiration. 

Dover's powder is a common and valuable agent in acute coryza, 
it also being one of the most efficient diaphoretics. 

Opium is considered the best remedy in puerperal septicemia. 
It has also been advocated for hemorrhage, both active and passive, 
its greatest utility being manifested in the latter condition. 

Although frequently used in continued fevers of various kinds, 
it is indicated as a rule only during their course — or, rather, after 
the fever is well estabhshed or during its decline — to mitigate its 
violence or conserve the strength and relieve the nervous manifes- 
tations foreboding exhaustion. Clinical experience has demon- 
strated its inutility, ordinarily, at the onset or cHmax of such fevers. 



442 A TEXT-BOOK OF MA TERIA MEDICA. 

Even in exanthematous fevers opium has proved valuable when the 
eruption is delayed. 

As already intimated, the space allotted to this drug will scarcely 
permit an enumeration of the many disorders for which this remedy 
has been successfully administered. The independent and thought- 
ful physician, knowing the chief indications for its use, will find no 
difficulty in employing opium alike to the relief of the patient and 
his own satisfaction. 

Contraindications. — If avoidable, opium should not be given 
to children under five years of age. Should the necessity of ad- 
ministration under that age be deemed advisable in the judgment 
of the physician, it should be remembered that the drug acts with 
greatly disproportionate power upon the nervous systems of the 
young, I minim (0.06 Gm.) of tincture of opium having caused the 
death of a child one day old, and a few drops of camphorated tinc- 
ture of opium having proved fatal to an infant of nine months. 
The death is even recorded of a nursing babe, from the mother 
having taken a medicinal dose of laudanum. 

Opium is contraindicated in excessive bronchial secretion of the 
aged during the second stage of pneumonia, in cerebral conges- 
tion, and in alcoholism. 

Administration. — As has been stated under Poisoning, there are 
many circumstances which modify the action of opium, the young 
and the old requiring smaller doses and great care in administra- 
tion. For children the best preparation is paregoric. Females, 
moreover, need smaller doses than males, since they are more 
readily affected by the drug and more subject to untoward mani- 
festations, such as nausea, headache, etc. 

Caution should be exercised in administering opium to those 
who have an idiosyncrasy against it. On the other hand, persons 
addicted to the opium habit require enormous doses to make a 
medicinal impression. 

Agonizing pain seems to antagonize the drug, so that in peri- 
tonitis or during the passage of biliary or renal calculi, in severe 
neuralgia, tic douloureux, etc., opium is well borne, doses which 
under other conditions might produce dangerous symptoms having 
little effect save to deaden the pain, frequently not even inducing 
sleep. 

In other cases, such as nephritis, very small doses may be fol- 
lowed by serious and alarming consequences, continued adminis- 
tration resulting in an accumulation of the drug in the system, 



NARCOTICS. 443 

owing to defective elimination. Should prolonged administration 
be desirable, it is necessary to increase the dose gradually in order 
to produce the requisite effect, because of the growing insensibility 
to the drug. 

Certain preparations are preferable in given conditions. Thus, 
if it be necessary to produce diaphoresis, Dover's powder or some 
other combination with ipecac is advisable. When rehef of pain, 
unless it be intense, is desired, small doses of morphine or tincture 
of opium will usually be sufficient, full doses being required to 
produce sleep. 

The deodorized tincture of opium causes less disagreeable 
symptoms than the plain preparation, which contains narcotine. 
Potassium bromide is said to prevent untoward after-effects. 

When opium is demanded for its astringent action, it should be 
given in small or stimulant doses or combined with chalk or with 
some of the astringents. The camphorated tincture, owing to the 
camphor it contains, is probably the most astringent liquid prepa- 
ration of opium, and is therefore preferable in cases of diarrhea, as 
it is the favorable form as an adjunct to cough-mixtures. 

When the prolonged sedative and astringent effect of opium is 
desired, as in intestinal hemorrhage^ diarrhea, nausea, and certain 
diseases of the stomach, an old, dry opium pill or pill of opium and 
lead is better than any hquid preparation or morphine, owing to its 
tardy solution. 

In diseases of the rectum requiring opium a suppository con- 
taining the extracts of opium and belladonna is perhaps the best 
combination to use. 

Ovarian and pelvic pain more readily succumbs to the anodyne 
action of codeine than distress in other parts of the body. 

When opium is used as a soporific, it is best to combine it with 
chloral, a small dose only of each being necessary. These unite 
in their action upon the brain, depressing the heart less than if 
chloral alone had been given, and attended by less serious after- 
effects than had morphine been the sole agent employed. 

Opium prolongs the narcotic effect of chloroform, and in cer- 
tain operations it is good practice to administer a dose of the drug, 
following it soon with a few inhalations of the anesthetic. 

The hypodermic injection of morphine is usually preferable to 
the internal administration of opium in cases of severe pain, since 
a smaller dose is required and a much more rapid effect produced, 
with less danger of affecting the appetite and bowels. 



444 ^ TEXT-BOOK OF MATERIA MEDICA. 

The many circumstances influencing the action of the drug 
appear to confirm the statement that " there is no dose of opium," 
its conduct being wholly dependent upon the age, sex, idiosyn- 
crasies, and condition of the patient. The amounts given under 
the different preparations are such as experience has shown to be 
safe ordinarily as the initial ones for adults, succeeding doses being 
adjusted according to the indications of the individual case. 

Opium compared with its Alkaloids. 

Morphine does not stimulate the nervous and circulatory sys- 
tems so much as opium, nor is it so decided a narcotic or con- 
vulsant. Morphine is more apt to excite nausea and vomiting, and 
its sequelae are of longer duration. 

Opium slightly increases the temperature — morphine lowers it ; 
and, while the former accelerates, the latter retards the pulse. 

The continued use of morphine hypodermically tends to con- 
stipate, while its prolonged action upon the stomach is apt to 
occasion diarrhea : under hke circumstances opium does not pro- 
duce diarrhea, its only effect being a cessation of confinement in 
the bowels. Morphine, therefore, ingested, fails to constipate, while 
opium is the better drug to check diarrhea. 

Morphine is excreted more readily than opium, and does not 
affect the secretion of bile. 

Opium possesses greater diaphoretic properties than morphine. 

Morphine produces more irritability of the bladder, frequently 
causing ardor urinae. It also occasions much greater itching of 
the skin, which usually begins and is intense about the eyes and 
nose. In its action as an anodyne and soporific morphine is more 
rapid and certain than opium. 

Codeine is a much feebler anodyne and hypnotic than morphine, 
4 grains (0.25 Gm.) being about equivalent to i grain (0.06 Gm.) 
of the latter drug. It produces sleep, however, freer from disturb- 
ance, with a less disagreeable sequel. 

Codeine has a more marked and selective action than morphine 
upon the nerves of the abdominal viscera. 

It possesses an advantage over both opium and morphine in that 
it can be given in increasing doses without producing narcosis. 

It is more stimulating to the spinal cord and sedative to the 
pneumogastric nerve than morphine. 

Codeine is superior to opium or morphine as a stimulant to the 
glycogenic function of the liver. In the treatment of diabetes mel- 



NARCOTICS. 445 

litus it surpasses all other drugs, almost invariably lessening, and 
often entirely removing, the sugar from the urine. In justice, how- 
ever, to authorities so eminent as Bruce, Frazer, and Osier it may 
be said that they consider morphine much more reliable than code- 
ine in diabetes, regarding the latter as nothing save a weak or 
diluted morphine. 

Admitting the general correctness of this opinion, codeine is 
nevertheless preferable to morphine or opium in prolonged admin- 
istration, as is necessary in diabetes, at least for the reasons that no 
untoward manifestations accompany its use, and that it does not 
engender an habitual proclivity for the drug. 

Finally, codeine is a valuable remedy in troublesome or nervous 
cough or to quiet the cough in bronchitis and phthisis, and is also 
efficient in gastrodynia. Codeine should be administered in water, 
syrup, elixir of orange, or in the form of pills or capsules. 

The true action of the following alkaloids is so questionable 
that they are seldom, if ever, prescribed : 

Narceine is alleged by equally competent observers to possess 
feeble hypnotic properties and to be practically inert. 

Narcotine is a misnomer, the preparation being devoid of nar- 
cotic power, although it is said to possess marked stomachic and 
antiperiodic properties. 

Papaverine is a mild hypnotic and cardiac sedative. 

Thebaine is a powerful tetanizing poison, its action upon the 
spinal cord being analogous to that of strychnine and brucine. 

Humulus— Humuli— Hops. IT. S. JP, 

Origin. — The strobile-like aments of Humulus lupuhis L., a 
rough, climbing perennial, native and cultivated in the north tem- 
perate zone. 

Description and Properties. — Ovate, about i^ inches (3.17 Cm.) 
long, consisting of a thin, hairy, undulating axis and many obliquely 
ovate, membranaceous scales, the upper portion of which is reticu- 
lately veined and the lower parallel-veined, glandular, surrounding 
a subglobular akene ; color of the scales greenish, free from red- 
dish or brownish spots, odor aromatic, and taste bitter, aromatic, 
and slightly astringent. The active and important constituent is — 

Lupullnum— LupulTni— Lupulin. TJ» S. I*. 

Origin. — A glandular powder separated from the aments of 
Humulus lupulus. 



446 



A TEXT-BOOK OF MATERIA MEDIC A. 



Description and Properties. — Bright, brownish-yellow, becom- 
ing yellowish-brown, resinous, consisting of minute granules which 
under the microscope are seen to be subglobular, or, rather, hood- 
shaped, and reticulate — aromatic and bitter. 

Dose of Lupulin. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations of Humulus. 

Tinctura Humuli — Tincturae Humuli — Tincture of Hops. — Dose, 1-2 fluid- 
drachms (4.0-8.0 Co.). 

Official Preparations of Lupulin. 

Extractum Lupulini Fluidum — Extr^cti Lupulini Fiaidi — Fluid Extract 
of Lupulin. — Dose, 5-30 minims (0.12-2.0 Co.). 

Oleoresina Lupulini — Oleoresinae Lupulini — Oleoresin of Lupulin.— Z>^i^^, 
i_5 grains (0.06-0.3 Gm.). 

Unofficial Preparations. 

Infiisum Humuli — Infiisi Hijmuli — Infusion of Hops. — Dose, 1-4 ounces 
(30-125 Cc). 

Tinctura Lupulini — Tincturse Lupulini — Tincture of Lupulin. — Dose, ^-2 
fluidrachms (2-8 Co.). 

Antagonists and Incompatibles. — Mineral acids and metallic 
salts. 

Synergists. — Alcohol; opium, lactucarium, and many other 
narcotics. 

Physiological Action. — Externally and Locally. — Hops are 
sedative and astringent. 

Lnternally. — Digestive System. — The action of hops is similar to 
that of vegetable bitters, augmenting the secretions from the sali- 
vary and gastric glands, thereby promoting appetite and digestion. 

Circulatory System. — The heart's action is slightly increased, the 
remedy also raising arterial tension and excitiiig the cutaneous cir- 
culation. 

Nervous System. — Like opium, hops primarily stimulate the 
brain, and secondarily act as a mild soporific. These effects are 
increased if the preparation be an alcoholic one, such as beer. 
The hypnotic action is due partly to the volatile oil which the hops 
contain. 

Respiratory System. — They slightly stimulate the respiration. 

Absorption and Eliminatio7i. — The active principles of hops are 
chiefly eliminated by the skin and kidneys, increasing considerably 
the sw^eat and urine. 



NARCOTICS. 447 

Temperature is unaffected. 

Untoward Action. — None is noticeable, although the drug pos- 
sesses marked aphrodisiac properties. 

Therapeutics. — Externally and Locally. — The sedative action 
of hops is utilized in what are known as hop poultices in superficial 
and abdominal inflammations, in orchitis, and as a preventive of 
cliordee. 

A hop pillow is frequently employed to induce sleep and allay 
the pain of earacJie, while, if the pillow be moistened with weak 
vinegar and the fumes inhaled, the result is found to be efficacious 
in the treatment of inflammatory co?iditions of the upper respiratory 
passages. 

Internally. — Its stomachic and carminative properties render this 
remedy valuable in atonic dyspepsia, so called, and in flatident colic. 
Preparations of hops are also useful in febrile restlessness. 

Priapism, perverted sexual appetite, spermatorrJiea, etc. may be 
relieved by lupulin. 

The combined tinctures of lupulin and capsicum serve as ex- 
cellent substitutes for alcoholic stimulants during the treatment 
of alcoholism, as well as being useful remedies in mild attacks of 
delirium treme?is. 

Administration. — Lupulin and oleoresin of lupulin are best 
given in pills and capsules respectively. The tincture and fluid 
■extract should be administered in syrup. 

Lactucarium— Lactucarii— Lactucarium. 77. >S^. J*. 

Origin. — The concrete milk-juice of Lactuca virosa L., a bien- 
nial rank-smeUing herb growing in Europe. 

Description and Properties. — It occurs in sections of plano- 
convex, circular cakes, or in irregular, angular pieces, externally 
grayish-brown or dull reddish-brown, internally whitish or yellow- 
ish, of a waxy lustre, heavy, narcotic odor, and somewhat bitter 
taste. It contains lactucin, lactucopicrin, lactucic acid, lactucerin, 
and wax. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparations. 

Tinctura Lactucarii — Tincturae Lactucarii — Tincture of Lactucarium. — 

Dose, \-'2 fluidrachms (1.0-8.0 Cc). 

Syrupus Lactucarii — Syrupi Lactucarii — Syrup of Lactucarium. — Dose, i- 
4 fluidrachms (4.0-15.0 Co.). 



448 A TEXT-BOOK OF MATERIA MEDICA. 

Synergists. — The same as for opium. 

Physiological Action and Therapeutics. — Its action closely 
resembles that of opium, save that it is very feeble, in adults never 
producing alarming symptoms. It is slightly soporific and anodyne, 
and also diuretic, which properties, especially in the syrup form, 
render it of some value in cases of irritating cough, as well as in 
sleeplessness and nervousness of children. 

Lactucin may be given in doses of from i to 5 grains (0.06-0.3 
Gm.) as a mild sedative and hypnotic. 

Cannabis Tndica— Cannabis Tndicae— Indian Can- 
nabis. V. S. JP. 

(Indian Hemp.) 

Origin. — The flowering tops of the female plant of Cannabis 
sativa L., grown in the East Indies. 

Description and Properties. — The article of commerce con- 
sists of bundles of a few flowers, the branches and bracts, and 
nearly ripe fruit, the whole more or less agglutinated by a resinous 
exudation. Of a brownish-green color, peculiar, narcotic odor, 
and sHghtly acrid taste. The drug contains a resin, cannabin, a 
brown, amorphous powder soluble in absolute alcohol, and a vola- 
tile oil. 

The crude drug is commonly called in India " gunjah." '* Bhang," 
" siddhi," or " hashish," the term usually employed — from whose 
toxic effects, frequently inciting to murder, is said to be derived our 
word " assassin " — is another form of cannabis appearing as the 
Arabian confection prepared by mixing aromatics with fruits and 
dried leaves. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Official Preparations. 

ExtrSctum Cannabis Indicse — ExtrScti Cannabis Indicae — Extract of In- 
dian Cannabis. — Dose, \-\ grain (0.015-0.06 Gm.). 

Extr^ctum Cannabis Indicae Fluidum — ExtrScti Cannabis Indicae Fluidi — 
Fluid Extract of Indian Cannabis. — Dose, 2-5 minims (0.12-0.3 Co.). 

Tinctijra Cannabis Indicse (15 per cent.) — Tincturae Cannabis Indicae. — 
Tincture of Indian Cannabis. — Dose, 5-20 minims (0.3-1.2 Co.). 

Unofficial Preparations. 

Cannabine Tannate. — Dose, 2-10 grains (0.13-0.60 Gm.). 
Cannabinone. — Dose, \-\ grain (0.03-0.06 Gm.). 



NARCOTICS. 449 

Antag-onists and Incompatibles. — Strychnine, caustic alkalies, 
acids, and aqueous preparations are pharmaceutical incompatibles, 
precipitating the resin. 

Synergists. — Alcoholics, ether, bromides, cocaine, and members 
of the present group enhance its cerebral effects. 

Physiological Action. — Externally and Locally. — Its only local 
action is that of a feeble sedative. 

Internally. — Digestive System. — It is slightly sedative to the 
stomach, in many persons appearing to promote the appetite and 
aid digestion. Its use is not followed by constipation or other 
gastro-intestinal disturbance. 

Circulatory System. — A slight acceleration of the pulse is notice- 
able, probably due more to the stimulation of the nervous system 
than to any direct action upon the circulatory apparatus. 

Nervous System. — Like opium, it primarily stimulates the brain, 
large doses producing a peculiar exhilaration and subsequent reac- 
tion more fully described under Poisoning. The period of excita- 
tion is more prolonged than with opium, but is eventually succeeded 
by sleep — almost always disturbed by dreams and spectral illusions. 
The coma resulting from cannabis is never so profound as in the 
case of opium. 

It is like the latter drug as an analgesic, but feebler in its action. 
It is unlike opium in producing a sensation of tingling and numb- 
ness, through its effect upon the sensory nerves, followed by 
cutaneous anesthesia, accompanied by muscular debility and fre- 
quently a cataleptic condition. 

Respiratory System. — No marked or uniform action upon the 
respiration has been observed, it being at times quickened and 
again retarded, though the effects are less pronounced than with 
opium. 

Absorption and Elimination. — Cannabis is slowly eliminated, 
though in what manner is unknown, the effects of the drug some- 
times persisting for twenty-four or thirty-six hours. Of all the 
secretions, the urine alone is affected, the amount being increased. 

Temperature. — Cannabis has no direct depressing action upon 
temperature, which, however, may rise during the period of excita- 
tion and be diminished somewhat during sleep. 

Eye. — The drug differs from opium in that it dilates the pupil 
and produces exaggerated vision. 

Uterus. — It is considered to be a powerful uterine stimulant, and 
like properties are usually ascribed to it as an aphrodisiac, though 

2^ 



450 A TEXT-BOOK OF MATERIA MEDICA. 

its effect upon sexual desire is not always manifest. It undoubtedly 
increases the energy of the uterus, though possessing no power to 
inaugurate uterine contractions when once suspended. 

Untoward Action, — The uncertain effects of different prepara- 
tions, together with varying susceptibilities to the drug, render it 
almost impossible to cite any characteristic untoward symptoms. 
Certain of the effects described under Poisoning may be present 
even under small doses in persons having an idiosyncrasy against 
the remedy. 

Poisoning. — Large doses of cannabis Indica are wont to produce 
toxic effects which in their manifestations present a singular study 
of psychological phenomena, varying with the temperament and 
idiosyncrasies of the subject, yet in certain characteristics common 
to all who experience the full force of the drug. The transition 
from the influence of medicinal doses to that exerted by poisonous 
absorption is often gradual, many features of the conditions result- 
ing therefrom being strikingly similar. 

Moderate administration, however, is seldom attended by unto- 
ward effects, whereas toxic doses, in place of emotional delight — 
among the earlier sensations — develop an intensity of mental 
anxiety which even contemplates death as the inevitable issue of 
the malady. The buoyancy of spirit, the soothing calm and 
insoucimice, the ecstasy of an ethereal mood by which finer natures 
are swayed, — these have given place to a mental and physical 
oppression best described as *' a sensation as of the brain boiHng 
over and lifting the cranial arch like the lid of a tea-kettle." Not 
infrequently the blissful nirvana induced by moderate doses is 
rudely broken by an intemperate use of the drug, extreme vio- 
lence and even murderous thoughts supplanting calmer reveries 
and the intellectual solace of passive emotions. Especially is this 
true among Oriental nations — the Hindustanis, for example — 
addicted to excessive indulgence in bliang or hashish, the form of 
the drug generally employed, its effects upon the grosser passions 
rivalHng those of opium among the Malays. 

Among the most curious and striking of the psychological 
phenomena attending immoderate doses of hashish is the abolition 
of space and time. So manifold are the images which throng the 
imagination, and so rapid and intense the impressions made upon 
the mind, that the sense of proportion and the normal relations of 
material objects become wholly lost. Thus, the furniture in the 
room may appear infinitely removed to the distorted vision, while 



1 



NARCOTICS. 451 

a few seconds of time may be prolonged by the disordered fancy 
into hours, days, weeks, and even years. These hallucinations, 
strangest of all, are not accompanied by corresponding loss of 
reasoning power, the intellect taking cognizance frequently of the 
true relations of external things, as if aware of its own abnormal 
condition. Nor is volition seriously affected, the mental lesion, so 
to speak, existing rather in lack of coordination between con- 
sciousness and the imaginative faculty. 

These spasmodic or persistent hallucinations are often associated 
with a haunting sense of dual existence, in which all trace of per- 
sonal identity is for the time either obliterated or hopelessly con- 
fused. During a certain stage of poisoning, moreover, the conviction 
of impending death takes possession of the mind ; fear and des- 
peration seize upon the bewildered faculties, intensified by an im- 
pression of physical dissolution ; and the subject endures unspeak- 
able anguish, in which gloomy forebodings of disaster contrast 
terribly with the buoyancy, the temporary joy, and peals of laughter 
accompanying the earlier effects of the drug. 

Upon regaining his normal condition the hashish-eater is either 
wholly oblivious of the events which have transpired during the 
interval of intoxication, or recalls vividly the scenes and incidents 
through which he has passed. As in the case of opium, the pecu- 
liar influence of the drug is largely dependent upon temperament, 
sex, age, and idiosyncrasy. A refined and noble intellect, like De 
Quincey's, might readily be moved to gentler emotions and sensi- 
bilities suffused with human sympathy and love. A baser, more 
unfeeling nature might exhibit latent symptoms of ungovernable 
passion manifested in sensual or criminal conduct scarcely con- 
ceivable either to himself or to others. 

The physiological symptoms characteristic of cannabis-poisoning 
are well marked, the drug acting reflexly yet powerfully upon the 
mental state. Loss of consciousness, followed by collapse or stupor, 
or in some cases resulting in catalepsy and convulsions, in all cases 
complete anesthesia, and in very many a depression of the pre- 
cordium, a sensation of arterial contraction, and cardiac palpitation, 
are among the prominent features of the malady. The sight and 
hearing are perceptibly rendered more acute ; the pupils are dilated, 
although contracting to light ; the reflexes are lowered by stimu- 
lation of inhibitory centers ; and an oppressive sense of paralysis 
in the extremities induces horror and despair. The urinary se- 
cretions are augmented, although constipation seldom occurs, 



452 A TEXT-BOOK OF MATERIA MEDICA. 

and a ravenous appetite almost invariably attends the toxic phe- 
nomena. 

Occasionally there is experienced great difficulty in breathing, 
as if the lungs were on the point of bursting. An increase of 
sexual desire is common, although the aphrodisiac properties of 
the drug are not always present. 

The after-effects of hashish indulgence vary with the physiolog- 
ical and mental peculiarities of the individual. As a rule, they are 
not disagreeable, though it requires time to eradicate the effects of 
the poison. Death directly attributable to the drug has not been 
recorded. 

Treatment of Poisoning. — Among antidotes, lemon-juice, coffee, 
and tobacco have been favorably mentioned. The best treatment 
appears to be similar to that adopted in cases of chloral- and 
opium-poisoning. 

Therapeutics. — Externally and Locally. — Cannabis is very 
seldom used locally, although it is an ingredient of a powder 
recommended by W. H. Beverly for insufflation in hay fever. 

Internally. — Cannabis has been discarded as a remedy in many 
disorders for which it was formerly used. It is, however, still 
employed to a considerable extent as an hypnotic in melancholia and 
mania and for its anodyne and anesthetic action in neuralgia and 
prnritus. 

As a uterine tonic and anodyne it has been found efficient, either 
alone or in combination with other medicines, in subinvolution y 
chronic metritis, dysmenorrhea, menorrhagia, etc. 

Probably there is no remedy superior to cannabis Indica in 
functional impotejice, its action in this disorder being aided by com- 
bining it with ergot and nux vomica. 

It is a valuable adjuvant to cough-mixtures intended to relieve 
tickling or irritation of the throat, as well as to quiet the excessive 
cough of bronchitis or phthisis, being superior to opium in this 
respect, since it disturbs the stomach less and does not produce 
constipation. 

It has been used in spasm of the bladder, and in gonorrhea and 
chordee it has been found to be a most valuable remedy. 

In considering the therapeutics of cannabis Indica reference 
should be made to its efficacy in migraine and headaches, particu- 
larly those present at the menopause. Although as a remedy for 
the former disorder cannabis has been largely superseded by the 
adoption of antipyrine and agents of its class, the old use of tine- 



NARCOTICS. 453 

ture of gelsemium, combined with tincture of cannabis, serves an 
important purpose in aborting the distressing attacks of migraine. 

Administration. — The extract should be given in pill form ; the 
tincture and fluid extract, in an alcoholic menstruum. As has been 
already intimated, different samples vary greatly in strength ; it is 
therefore best to begin with the minimum dose until the force and 
quality of the preparation be ascertained. 

It is advisable to prescribe invariably the preparations of that 
particular manufacture which experience has shown to produce 
samples of uniform strength. 



The following drugs — Belladonna, Stramonium, Hyoscyamus, 
Duboisia, and Dulcamara — belong to the Solanacese, and are by 
some authors classed as Mydriatics, on account of their character- 
istic action on the pupil. It has been thought best in the present 
work to include them in the subdivision of Narcotics, because of 
their narcotic properties, utilized clinically in the treatment of dis- 
eased conditions. 

Belladonna is considered the type of the Mydriatic Narcotics, 
and claims the first attention. Two portions of the plant are used 
— the leaves and the root. 

Belladonnae Folia— Belladonnae Foli5rum— Bella- 
donna Leaves. JJ> S. jP. 

Origin. — The leaves of Atropa Belladonna L., a nearly glabrous, 
herbaceous, perennial plant, from 4 to 6 feet (1.2-1.8 M.) high, 
bearing dark-purple, bell-shaped flowers and shining purpHsh- 
black berries of the size of a cherry. It is found in the woods, 
chiefly in the mountainous districts, of Central and Southern Eu- 
rope, and as far east as Asia Minor, Caucasia, and Central Asia. 
It is cultivated in Europe and in the United States to some extent, 
being known by the common name of " deadly nightshade." 

Description and Properties. — The leaves are from 4 to 6 
inches (10-15 Cm.) long and about one-half as broad, broadly 
ovate, equilaterally narrowed into a petiole, tapering at the apex, 
entire on the margin, smooth, thin, the upper surface brownish- 
green, the lower surface grayish-green, both surfaces whitish punc- 
tate ; odor slight, taste bitterish and disagreeable. 

Belladonna leaves contain from 0.2 to 0.6 per cent, of atropiiie, 
the most important alkaloid, belladonnine (probably anhydro-atro- 



454 ^ TEXT-BOOK OF MATERIA MEDICA. 

pine), besides an alkaloid identical with Jiyoscyamme, duboisiney 
daturine, atropamine — sometimes present — and chrysatropic acid 
(scopaline). 

Dose. — 1-5 grains (0.06-0.30 Gm.). 

Official Preparations. 

Extractum Belladonnae Folidrum Alcoh61icum — Extr^cti BelladSnnae Fo- 
liorum AlcohSlici — Alcoholic Extract of Belladonna Leaves. — Dose, i-| grain 
(0.008-0.048 Gm.). 

Empiastrum Belladonnae (20 per cent.) — Empl^strum (ace.) Belladonnse — 
Belladonna Plaster. — For external use. 

Formula: Alcoholic Extract of Belladonna Leaves, 200; Resin Plaster, 400 ; Soap 
Plaster, 400. 

Tinctiara BelladSnnae Foliorum (15 percent.) — Tincturae BelladSnnse Folio- 
rum — Tincture of Belladonna Leaves. — Dose, 5-20 minims (0.3-1.2 Cc). 

Ungu6ntum Belladonnse (10 per cent.) — UnguSnti Belladonnae — Belladonna 
Ointment. — For external use. 

Formula: Alcoholic Extract of Belladonna Leaves, 10; Diluted Alcohol, 5; Ben- 
zoinated Lard, 85. 

Belladonnae Radix— Belladonnae Radicis— Bella- 
donna Root. JJ. S. JP. 

Description and Properties. — The root of Atropa Belladonna 
occurs in cylindrical, somewhat tapering, longitudinally wrinkled 
pieces, ^ inch to i inch (12-25 Mm.) thick; externally brownish- 
gray, internally whitish ; fracture nearly smooth and mealy, not 
radiating or showing medullary rays in the thicker roots, except in 
the layer near the bark ; nearly inodorous, of sweetish taste, after- 
ward bitterish and strongly acrid. 

The root contains the same constituents as the leaves, with the 
exception of chrysatropic acid — which is wanting — and in addition 
a red coloring principle, atrosin, found also in the berries. 

Offiicial Preparations. 

Extr^ctum Belladonnae Radicis Fluidum— Extr^cti Belladonnae Radicis 
Fluidi — Fluid Extract of Belladonna Root. — Dose, 1-3 minims (0.06-0.18 Cc). 

LinimSntum Belladonnae (95 per cent.) — LinimSnti Belladonnae — Bella- 
donna Liniment. — For external use. 

Formula: Camphor, 50; Fluid Extract of Belladonna Root, 950. 

The important alkaloid of belladonna is — 

AtropTna—AtropInae— Atropine. JJ. S. JP. 

Description and Properties. — White acicular crystals, or a 
more or less amorphous white powder, odorless, having a bitter. 



NARCOTICS. 455 

acrid taste, gradually assuming a yellowish tint on exposure to air. 
Soluble in 130 parts of water, 3 parts of alcohol, 16 parts of ether, 
4 parts of chloroform, and, about 50 parts of glycerin. 
Dose. — x^o"~To gi'a-in (0.0005-0.0016 Gm.). 

Atroplnae Sulphas— At ropTnae Sulphatis— Atropine 
Sulphate. V, S. I". 

Description and Properties. — A white, indistinctly crystalline 
powder, odorless, having a very bitter, nauseating taste, permanent 
in air. Soluble in 0.4 part of water, 6.2 parts of alcohol, 2270 
parts of ether, and 694 parts of chloroform. 

Dose. — y Iq - ^q grain (0.0005-0.0016 Gm.). 

HOMATROPINA — H0MATROPIN.E HoMATROPINE. 

An unofficial and derivative alkaloid, obtained by the action of 
dilute hydrochloric acid on amygdalate of tropin. The hydrobro- 
mate of homatropine is used only as a mydriatic. 

Allied Plants. 

Atropa MandrSgora L., Mandrake, closely resembles Atropa Belladonna. It pos- 
sesses marked anesthetic properties, and contains a mydriatic alkaloid. It is especially 
interesting because of its ancient history, its action having been fully described by 
Dioscorides and Pliny. Historians and poets have alike celebrated its peculiar and 
wonderful properties. 

Sc6polia CarniSlica and Scfipolia Japdnica both resemble belladonna physic- 
ally, and somewhat in their physiological action, the roots and leaves of these plants 
having been found mixed with those of belladonna. 



Antagonists and Incompatibles. — Muscarine antagonizes the 
action of belladonna in nearly every particular, and physostigmine, 
pilocarpus, and aconite counteract many of its effects. Opium an- 
tagonizes its action on the cerebrum, pupil, heart, respiration, arterial 
tension, and kidneys. 

Atropine is incompatible with caustic alkalies, tannin, and vege- 
table infusions containing tannin, an insoluble tannate of the alka- 
loid being formed. 

Synergists. — The mydriatic drugs mentioned above aid the 
action of belladonna. 

Physiological Action. — The action of belladonna is dependent 
upon the amount of atropine it contains. 

Externally and Locally. — When locally applied atropine is 
anodyne, antispasmodic, resolvent, antisecretory, and mydriatic. 



45^ A TEXT-BOOK OF MA TERIA MEDIC A. 

When thus used, in combination with absorbable substances — 
such as alcohol, camphor, animal fats, glycerin, etc. — it diminishes 
the sensibility of the sensory nerves, and when absorbed from raw 
surfaces of the skin or from the subcutaneous tissue it is capable 
of producing systemic effects. 

Intemially. — Digestive System. — Even small doses produce dry- 
ness of the mouth, owing to the greatly diminished secretion of 
saliva and mucus. The salivary secretion is lessened through 
paralysis of the peripheral endings of the chorda tympani nerve 
in the submaxillary gland. 

The drug probably diminishes the secretions from the stomach, 
liver, pancreas, and intestines in a similar manner. It is reasonable 
to suppose that it produces these effects, since it checks all other 
secretions, with the possible exception of the urine. The sweat is 
diminished through paralysis of the peripheral nerve-endings in the 
sudoriparous glands. The secretion of milk is reduced by paral- 
ysis of the peripheral terminations of the secretory nerves in the 
mammary glands. The secretion from the bronchial mucous mem- 
branes is lessened through the depressing influence of the drug 
upon the nerve-endings. 

Brunton claims that the peristaltic movements of the intestines 
are increased by small doses, large doses checking them. 

This he considers due to the action of the drug upon the 
nervous ganglia in the walls of the intestines. It is a well-known 
fact that atropine paralyzes the motor nerve-endings in unstriped 
muscles. This is shown by its action on the vagus endings in the 
heart, which organ it completely paralyzes, stimulation of the 
vagus having no longer any effect. The action of atropine on the 
intestines is easily shown by exposing the intestines of a cat, the 
viscera being immersed in a warm, physiological salt solution. 
Upon the injection of muscarine the peristaltic action is much 
increased ; but upon the injection of even a minute quantity of 
atropine the peristaltic action is at once arrested. It is an estab- 
lished fact that muscarine stimulates the nerve -endings, while the 
same points are paralyzed by atropine. Muscarine has no action 
after atropine ; nor has electric stimulation of the supposed motor 
nerves (vagus) connected with intestines any influence, showing 
conclusively that atropine, even in small doses, does not increase 
peristalsis. 

Circulatory System. — Medicinal doses of atropine or belladonna 
at first retard the pulse, but it is quickly accelerated and rendered 



NARCOTICS. 457 

firmer, with increased arterial pressure. The primary transitory 
action is due to a slight stimulation of the vagi roots, the subse- 
quent quickening of the pulse resulting from paralysis of the 
peripheral ends of the pneumogastric nerve distributed in the car- 
diac muscle. The inhibition being thus removed, the heart re- 
sponds to the influence of the accelerator nerves. The center for 
these nerves in the medulla is also stimulated by the drug, increas- 
ing still further the rapidity of the heart's action. The cardiac 
muscle itself, being stimulated, renders the contractions of the 
heart more forcible. 

Arterial tension is increased not only by the greater rapidity 
and force of the heart, but also by the contraction of the arterioles 
arising from stimulation of the vaso-motor center. Very large or 
poisonous doses lower arterial pressure. This effect is produced 
by exhaustion of the vaso-motor center from over-stimulation, 
resulting in dilatation of the cutaneous arterioles, which lowers 
arterial tension and flushes the skin. Overwhelming doses may 
weaken the cardiac muscle itself from over-stimulation, weakening 
the heart's contractions, as well as paralyzing the terminal nerve- 
filaments in the muscles of the vessel-walls, and even the muscular 
fibers. 

Nervous System. — A full medicinal dose of belladonna stimulates 
the brain, while large doses — and, in susceptible persons, medicinal 
ones — may produce hallucinations and delirium, accompanied by 
spectral illusions. The delirium maybe mild, joyful, and talkative, 
or it may assume a violent type. It may, moreover, persist for a 
long time, after which the patient sinks to sleep, induced either by 
exhaustion from the dehrium or a secondary depressing action of 
the drug. True coma, like that produced by opium, rarely if ever 
occurs. 

The spinal cord shares in the stimulation caused by belladonna. 
The reflexes are at first sHghtly exaggerated, being afterward 
diminished. Very often under poisonous doses there is complete 
motor paralysis, the loss of power occurring first in the lower 
extremities. 

The sensory nerves are depressed, especially when the drug is 
locally applied, the influence being exerted on their terminal fila- 
ments. For this reason belladonna is of little service as an ano- 
dyne when given internally. 

Respiratory System. — Medicinal doses quicken and deepen the 
respirations, owing to stimulation of the respiratory center. The 



458 A TEXT-BOOK OF MATERIA MEDIC A. 

peripheral nerve-filaments of the pulmonary vagi are, however^ 
depressed ; which, were it not for the increased action of the center^ 
would retard respiration. 

Poisonous doses over-stimulate, and consequently exhaust or 
paralyze, the respiratory center, the result being slow and shallow 
breathing or perhaps death from asphyxia. 

Absorption and Elimination. — Atropine is rapidly absorbed and 
eliminated, chiefly by the kidneys, but also to some extent by the 
bowels. It is said that part of the drug is destroyed by the liver. 

Temperature. — Large doses increase bodily heat, probably by 
increasing the circulation and respiration, consequently augmenting 
combustion. Some authors maintain that belladonna stimulates 
the heat-center. In cases of severe poisoning from the drug the 
temperature rapidly falls. 

Eye. — Belladonna dilates the pupil, whether locally applied or 
taken internally, its effect differing from that of cannabis Indica in 
that the pupil cannot be made to contract by stimulation of the 
third nerve, although excitement of the muscle itself causes pupil- 
lary contraction. The manner in which atropine dilates the pupil 
is not yet satisfactorily explained, the prevailing opinion being in 
favor of Jessup's theory that the action is due to a stimulation of 
the ends of the sympathetic nerve-filaments distributed to the iris, 
and paralysis of the peripheral ends of the oculo-motor nerves. 

Atropine increases intraocular tension, rendering it a dangerous 
drug in glaucomatous conditions. 

Untoward Action. — Very frequently there appears, especially in 
children, an erythematous or scarlatinal eruption, oftener noticeable 
on the face and neck, but sometimes affecting the entire surface of 
the body. Redness and pain in the throat may also be present, but 
no fever, with itching of the skin or desquamation. 

Occasionally instillation of atropine into the eye produces pro- 
fuse lacrymation, edema of the eyelids, and blepharo-conjunctival 
irritation. 

When taken internally in medicinal doses it sometimes occasions 
in certain persons vertigo, turgescence of the face, hallucinations, 
erethistic debility, and impaired assimilation. 

Homatropine has caused dizziness, uncertainty of gait, fatigue, 
difficulty in deglutition, and loquacious deUrium. 

Poisoning. — The poisonous actions of belladonna may be sum- 
marized as follows : 

The skin is dry and hot; the conjunctivae are congested, with,. 



NARCOTICS. 459 

possibly, edema of the eyelids and pupils widely dilated ; the face 
is swollen, while the whole body may be covered with an erythem- 
atous rash, and there is a sensation of heat and pain in the throat 
and difficulty in swallowing. 

Rapid respirations, muscular weakness, and incoordination of 
movements appear ; the patient becomes dizzy or mildly or violently 
delirious, continually talking, shouting, or laughing. While there 
is a constant desire to micturate, there is an inability to pass 
any urine. At this stage the respirations are slow and shallow. 
Finally, convulsions may occur, and the patient sink into a coma- 
tose condition and die from asphyxia and cardiac exhaustion. 

Treatjnent of Poisoning. — Wash out the stomach with solutions 
of tannic acid, pursuing the treatment with the cautious adminis- 
tration of physostigmine, opium, or the hypodermic injection of 
pilocarpine. Should cardiac failure be pronounced or the patient 
lapse into a state of stupor, stimulants and the subcutaneous injec- 
tion of caffeine are indicated, the patient being aroused meanwhile 
and kept awake if possible, respiration being maintained by the use 
of strychnine and by artificial means when necessary. Should the 
temperature fall below normal, external heat must be applied. . 

Atropine compared with Morphine. 

Atropine stimulates respiration ; morphine is a powerful respi- 
rator>^ depressant. Atropine dilates the pupil ; morphine contracts 
it. Atropine increases bodily heat, and frequently reddens the 
surface of the skin ; morphine produces pallor of the skin and 
lowers temperature. 

Both drugs lessen peristaltic action of the bowels. Atropine 
reinforces the functional activity of the kidneys ; morphine lessens 
it. On the other hand, atropine checks the secretion from the 
skin, while morphine increases it. 

The remaining secretions are diminished by both drugs, but in 
different ways. Atropine, for instance, checks secretion by depress- 
ing the peripheral terminations of the secretory nerves ; morphine, 
by depressing the secretory center in the medulla. 

Both drugs depress the sensory mechanism, yet again by differ- 
ent actions, atropine depressing the function of the sensory nerve- 
terminations, and morphine depressing the center mainly, although 
to some extent influencing the entire sensory tract. 

Atropine acts rather as a cerebral excitant, producing delirium, 
hallucinations, and disturbed sleep ; morphine is more of a cerebral 



460 A TEXT-BOOK OF MATERIA MEDIC A. 

depressant, the period of mental excitation being comparatively 
brief, while sleep is longer and more profound. 

In medicinal doses atropine contracts the arterioles ; morphine 
dilates them. Again, while morphine, like atropine, causes the 
heart to beat faster and stronger, it is by no means so powerful a 
cardiac stimulant as atropine. 

In many respects these drugs are mutually synergistic. Both 
relieve pain, though morphine is much the more powerful anodyne. 
Both cause incoordination of muscular movements and mental 
confusion. 

Although in many respects antagonistic, they are frequently 
combined when an anodyne action is desired. As has been forcibly 
suggested, their reciprocal influence, when administered together, 
modifies in a remarkable manner their physiological effects. 

Therapeutics. — The many uses for which belladonna has 
been employed would render it a difficult, perhaps useless, task 
to enumerate them. As in the case of opium, there are cer- 
tain general and important actions in disease which the physician 
can utiHze in daily practice, a succinct mention of which is ap- 
pended : 

1. Belladonna is serviceable in relaxing spasms of invol- 
untary MUSCLES, as in asthma, spasmodic colic, lead colic, spasmodic 
dysmenorrhea, laryngismus stridulus, etc. 

2. In diminishing secretion, as in acute coryza, bronchitis, night- 
sweats of phthisis, and to check the secretion of milk, mercurial 
ptyalism, etc. 

3. In relieving pain, either combined with opium or morphine, 
or alone, particularly where it can be applied locally, as in lumbago, 
neuralgia, pleurodynia, etc. 

4. Belladonna is used to stimulate the circulatory system 
in cases of a weak heart and low arterial tension, as in fevers, etc. 

5. For its peculiar action upon the eye in ophthalmo- 
LOGICAL practice, to dilate the pupil, prevent adhesion, remove 
congestion, reheve pain, and afford rest. 

While, as has been said, it is impossible to mention in detail the 
manifold uses of belladonna, its more important therapeutic services 
may be here mentioned : 

Externally a7td Locally. — Belladonna ointment is useful in the 
treatment of boils, carbuncles, chrojiic inflammatory conditions about 
the aj'ticulations, chronic synovitis of the knee-joint, its efficiency in 
the latter condition being enhanced by combining it with mercurial 



NARCOTICS. 461 

ointment. Orchitis is greatly relieved by covering the testicle with 
belladonna ointment. Suppositories containing extract of bella- 
donna are beneficial in the treatment of hemorrhoids and in anal 
fissure. A rigid os may be made to dilate, hastening delivery, by 
smearing the cervix with the ointment of this drug. 

Eczema and excessive sweating of certain areas of the skin, such 
as the palms and soles, are benefited by a local apphcation of the 
tincture or the dried and powdered extract mixed with some inert 
desiccant powder hke powdered talcum. 

Belladonna plaster is one of the most useful applications in cases 
of acute or chrojtic muscidar rheumatism, and in certain forms of 
neuralgia. In its power to arrest the secretion of milk the drug 
is perhaps without an equal. Should inflammation have already 
set in and the breasts be swollen and painful, the ointment is to be 
appHed and the breasts covered with hot flaxseed poultices, the 
parts being entirely supported by wide bandages. 

Internally. — Belladonna is combined with opium to relieve the 
pain of gastralgia and e?tteralgia, while its combination with strych- 
nine and iron is useful in anennc neuralgia. 

Next to bromoform, it is the most efficient remedy in whooping 
cough; the spasmodic manifestations of hysteria are also favorably 
affected by full doses of tincture of belladonna. 

Nocturnal incontinence of urine in children, when resulting from 
supersensitiveness of the mucous membrane of the bladder, derives 
signal benefit from this drug. By depressing the ends of the sen- 
sory nerves distributed to the bladder belladonna prevents the irri- 
tation of the accumulated urine from being conveyed to the center 
in the cord, and from there reflexly exciting the detrusor muscle 
of the sphincter and causing micturition. 

Belladonna combined with strychnine stimulates the respiration 
and checks the sweating in phthisis. A similar union with some 
laxative drug makes an exceedingly useful pill in habitual constipa- 
tion, while the obstinate constipation due to lead-poisoning is greatly 
relieved by belladonna. 

This drug, as well as the other mydriatic narcotics, is one of the 
most reliable remedies we possess to relieve the symptoms of spas- 
modic asthma. It is highly recommended also by many physicians 
in typhoid fever to support the circulation and reHeve many dis- 
tressing symptoms of the disease. In scarlatina, too, it is thought 
to be a useful remedy. 

Cardiac pain and distress due to over-action of the heart are 



462 A TEXT- BOOK OF MATERIA MEDIC A. 

alleviated by the application of belladonna plaster over the cardiac 
region or by the internal use of the drug. 

hitestinal, hepatic^ and renal colic ^ cystitis, prostatitis, spermator- 
rhea, exophthalmic goiter, cerebral and spinal hyperemia, sea-sickness, 
facial erysipelas, and menorrhagia have all apparently been favor- 
ably influenced by belladonna. 

Atropine subcutaneously injected is a powerful antidote to chlo- 
roform-, physos tig ma-, aconite-, di.r].d jab orandi-poisoning , as well as 
that contracted from toadstools. 

Administration. — The crude drug, leaves, and root are seldom 
if ever used. Owing to its action in diminishing secretion, it is 
better to time the internal administration of belladonna so as to 
interfere as little as possible with the process of digestion. 

Children are peculiarly insusceptible to this drug, sometimes 
tolerating as large doses as adults. 

When atropine is used hypodermically in cases of sciatica or 
neuralgia, the injection should be made deeply in close proximity 
to the affected nerve-trunk. 

The part of the body to which a belladonna plaster is to be 
applied should be first thoroughly cleansed and dried, the exact 
area to be covered being specifically designated by the physician. 
Caution should be exercised in the application, lest too large a 
space be covered by the plaster and dangerous symptoms super- 
vene from absorption of its more active constituents, a result which 
may also occur from too prolonged contact, from three to five days 
being usually sufficient. Should it be desirable to continue the 
influence of the drug, the application of fresh plaster from time to 
time will produce better results than too long use of a single one. 

Stramonii Folia— Stramonii Foliorum— Stramonium 
Leaves. TI, S. I*. 

(Thorn-apple; Jamestown or Jimson Weed.) 

Origin. — The leaves of Datura Stramonium L., a coarse-look- 
ing annual weed, believed to be a native of Asia, but found grow- 
ing in waste places and along roadsides throughout the greater 
part of the world. 

Description and Properties. — From 3 to 8 inches (7-20 Cm.) 
long, petiolate, dark-green, smooth, ovate, pointed, unequal, espe- 
cially at the base, coarsely and sinuately toothed ; thin, brittle and 
nearly inodorous ; taste unpleasant, bitter and nauseous. Stramo- 



NARCOTICS. 463 

nium leaves contain about 0.2 per cent, of a mixture of atropine 
and hyoscamine known as daturine. 
Dose. — 1-5 grains (0.06-0.3 Gm.). 

Stramonii Semen— Stramonii Seminis— Stramo- 
nium Seed. U.S. I". 

Origin. — The seed of Datura Stramonium L. 

Description and Properties. — About \ inch (4 Mm.) long, 
reniform, flattened, pitted and wrinkled, testa dull brownish-black, 
hard, enclosing a cylindrical, curved embryo imbedded in a whitish, 
oily perisperm ; of an unpleasant odor when bruised, and of an 
oily and bitter taste. 

The seeds contain a larger proportion of daturine than the 
leaves, besides scopaUmine, resin, fixed oil, etc. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Official Preparatiojis. 

ExtrSctum Stramonii SSminis — Extr^cti Stramonii SSminis — Extract of 
Stramonium Seed. — Dose, ^-\ grain (0.02-0.03 Gm.). 

ExtrSctum Stramonii SSminis Fluidum — ExtrScti Stramonii SSminis 
Fliiidi — Fluid Extract of Stramonium Seed. — Dose, 1-3 minims (0.06-0.2 Cc). 

Tinctura Stramonii SSminis — Tinctiirae Stramonii SSminis — Tincture of 
Stramonium Seed (15 per cent.). — Dose, 5-10 minims (0.3-0.6 Cc). 

UnguSntum Stramonii — UnguSnti Stramonii — Stramonium Ointment (10 
per cent, of extract). — For external use. 

Antagonists and Incompatibles and Synergists are the same 
as for belladonna. 

Physiolog-ical Action. — The action of stramonium is almost 
identical with that of belladonna, the main difference being the 
influence of stramonium upon the sympathetic system, the motor 
and sensory nerves being less powerfully affected than by bella- 
donna. Stramonium is more apt to occasion irregular action of 
the heart, and the involuntary muscle-fibers of the bronchial tubes 
are relaxed more by stramonium than by belladonna. It usually 
occasions more delirium and is more of an aphrodisiac than bella- 
donna. 

Poisoning and Treatment of Poisoning are precisely the same as 
described under Belladonna. 

Therapeutics. — The medical uses of belladonna are applicable 
to this drug, although stramonium is much the better remedy in 
spasmodic asthma. The stramonium ointment appears to be 



464 A TEXT-BOOK OF MATERIA MEDICA, 

superior to that prepared from belladonna as an application to 
painful hemorrhoids. 

Administration. — No special directions are necessary, any of 
the preparations being serviceable. For asthma the leaves may be 
smoked in a pipe or in the form of cigarettes, this method of em- 
ploying the drug to relieve bronchial spasm being probably superior 
to internal administration. 

Hyoscyamus— Hyoscyami— Hyoscyamus. 77. >S^. IP. 

(Henbane.) 

Origin. — The leaves and flowering tops of Hyoscyamus niger L., 
collected from plants of the second year's growth. Henbane is a 
biennial growing in sandy soil and waste places throughout the 
greater portion of Europe and Asia, and naturahzed in North 
America. 

Description and Properties. — Leaves ovate or obovate-oblong, 
up to 10 inches (25 Cm.) long and 4 inches (10 Cm.) broad; sinu- 
ate-toothed, the teeth large, oblong, or triangular; grayish-green, 
and, particularly on the lower surface, glandular-hairy ; midrib 
prominent ; flowers nearly sessile, with an urn-shaped, five-toothed 
calyx and a light-yellow, purple-veined corolla ; odor heavy, nar- 
cotic ; taste bitter and somewhat acrid. 

The active constituents are hyoscyamine and hyoscine, and a very 
poisonous volatile oil is obtained by distillation of the leaves, which 
contain also a small percentage of potassium nitrate. 

Dose of the Leaves. — 5-15 grains (0.3-1.O Gm.). 

Official Preparations. 

Extr^ctum Hyoscyami — ExtrScti Hyoscyami — Extract of Hyoscyamus. — 
Dose, 1-3 grains (0.06-0.2 Gm.). 

ExtrSctum Hyoscyami Fluidum — Extr^cti Hyoscyami Fluidi — Fluid Ex- 
tract of Hyoscyamus. — Dose, 5-15 minims (0.3-1.0 Co.). 

Tinctiira Hyoscyami — Tincturse Hyoscyami — Tincture of Hyoscyamus 
(15 per cent.). — Dose, 10-60 minims (0.6-4.0 Cc). 

HyoscTnae Hydrobr5mas— Hyosclnae Hydrobro- 
matis— Hyoscine Hydrobromate. TJ. S. JP. 

Origin. — The hydrobromate of an alkaloid obtained from Hy- 
oscyamus. 

Description and Properties. — -Colorless, transparent, rhombic 
crystals, odorless, and having an acrid, slightly bitter taste ; perma- 



NARCOTICS. 465 

nent in the air. Soluble in 1.9 parts of water and in 13 parts of 
alcohol. It should be kept in small, well-stoppered vials. 
Dose. — rJo~A" grain (0.0006-0.OO i Gm.). 

Hyoscyamlnae Hydrobromas— Hyoscyamlnae Hy- 
drobromatis — Hyoscyamine Hydrobromate. 
V. S. JP. 

Origin. — The hydrobromate of an alkaloid obtained from Hy- 
oscyamus. 

Description and Properties. — A yellowish-white, amorphous, 
resin-like mass or prismatic crystals, having, particularly when 
damp, a tobacco-like odor and an acrid, nauseous, and bitter taste. 
Deliquescent on exposure to the air ; soluble in about 0.3 part of 
water and 2 parts of alcohol. It should be kept in small, well- 
stoppered vials. 

Dose. — xio~A" g^^""^ (0.0006-0.0015 Gm.). 

Hyoscyamlnae Sulphas— Hyoscyamlnae Sulphatis 
—Hyoscyamine Sulphate. U» S. I*. 

Orig-in. — The neutral sulphate of an alkaloid obtained from 
Hyoscyamus. 

Description and Properties. — White, indistinct crystals or a 
white powder, without odor, and of a bitter, acrid taste ; deliques- 
cent in damp air. Soluble in 0.5 part of water and 2.5 parts of 
alcohol. It should be kept in small, well-stoppered bottles. 

Dose. — ToT~A" gr^i^ (0.0006-0.0015 Gm.). 



Antagonists, Incompatibles, and Synergists the same as for 
belladonna. 

Physiological Action. — The action of hyoscyamus is analo- 
gous to that of belladonna, with the following differences : 

1. Hyoscyamus does not depress the peristaltic action of the 
intestines as m.uch as belladonna, but is more efficient in relieving 
the griping and pain occasioned by the rougher cathartics. 

2. It is less powerful than belladonna as a cardiac stimulant, 
though stronger than stramonium. 

3. It does not occasion nearly so much mental excitement as 
belladonna, on account of the hyoscine it contains, which is a 
powerful hypnotic and cerebral and spinal sedative. 



466 A TEXT-BOOK OF MA TERIA MEDICA. 

4. As a urinary sedative hyoscyamus is greatly superior to 
belladonna. 

5. It differs from belladonna in affecting the respiration less 
powerfully. 

Untoward Action^ Poisoning, and Treatment of Poisoning are the 
same as for belladonna. 

Therapeutics. — Hyoscyamus may be used for the same pur- 
poses as belladonna, but is considered superior to the latter drug 
as a urinary sedative in the treatment of incontinence of urine, 
vesical tenesmns, cystitis, prostatitis, etc. 

For the relief of colic of various forms, and to allay the gripijzg 
produced by certain purgatives, hyoscyamus is better than bella- 
donna. 

In mental and convulsive diseases, such as delusional insa7tity, 
delirium tremens, acute and febrile marda, insomnia, clironic dementia, 
hysterical convidsions, chorea, paralysis agitans, etc., hyoscyamus, 
particularly hyoscine, is superior to belladonna. 

Hyoscyamus and its alkaloids are fully equal to belladonna in 
the treatment of asthma, zvhooping cough, neuralgia, enteralgia, etc. 

As an anodyne and hypnotic for children hyoscyamus is safer 
than, and frequently as efficient as, opium. 

Contraindications.^ — The same as for belladonna. 

Administration. — Like belladonna, this drug should be admin- 
istered tentatively. Any of the preparations may be given. The 
salts of the alkaloids may be administered either subcutaneously 
or internally. 

The hyoscine is tasteless, and may be easily given in various 
drinks. When used internally its action is slower, but more pro- 
longed, than when given hypodermically, though the dose under 
the former method should be twice that of the latter. 



GROUP VI.— MOTOR EXCITANTS. 

The drugs belonging to this group excite the functional activity 
of the spinal cord and the sympathetic nervous system. They 
serve to stimulate muscular contraction and the functional opera- 
tions of the heart, lungs, and secretory apparatus. 

It is difficult to separate by sharply-defined limits the remedies 
having these actions, and group them according to their analogous 
therapeutic uses. 



MOTOR EXCITANTS, 467 

In the present group, for instance, are placed ergot and gossyp- 
ium, chiefly used for their action upon the uterus, while those 
drugs which, although excito-motors, are employed principally for 
their action upon the circulatory system are placed in the group, 
Cardiac Stimulants. 

The motor excitants are exceedingly valuable remedies, the 
typical member of the group being Nux Vomica, and therefore 
first considered. 

Nux Vomica— Nucis Vomicae-Nux Vomica. 

77. H. jP. 

Origin. — The seeds of Strychnos Nux Vomica L,, a small tree 
common in many parts of Hindustan, Farther India, some of the 
East Indies, and in some parts of Australia. 

Description and Properties. — Nux vomica is about i inch 
(25 Mm.) in diameter, orbicular, grayish or greenish-gray; soft- 
hairy, of a silky luster, w^ith a slight ridge extending from the 
center of one side to the edge ; internally horny, somewhat trans- 
lucent, very tough, with a large circular cavity, into which the 
heart-shaped, nerved cotyledons project. It is inodorous and per- 
sistently bitter. 

Nux vomica contains two important alkaloids — strychnine and 
brucine, the former being in excess. The seeds also contain iga- 
suric acid, with which these alkaloids are combined. Of total 
alkaloids the drug should contain from 2.5 to 5 per cent. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparations. 

Extractum Nucis Vdmicse — ExtrScti Nucis Vomicae — Extract of Nux 
Vomica. — Dose, \-\ grain (0.008-0.03 Gm.). 

Extr^ctum Nucis VSmicae Fluidum — Extr5cti Nucis Vomicae Fluidi — 
Fluid Extract of Nux Vomica. — Dose, 1-5 minims (0.06-0.3 Cc). 

Tinctura Nucis V6micae — Tincturae Nucis V6micae — Tincture of Nux 
Vomica. — Dose, 5-20 minims (0.3-1.2 Cc). 

Strychnlna— Strychnlnae— Stryciinine. U.S. I", 

Orig-in. — An alkaloid obtained from Nux Vomica, and also 
derived from other plants of the natural order LoganiacecB. 

Description and Properties. — Colorless, transparent, octahedral 
or prismatic crystals, or a white, crystalline powder, odorless and 
having an intensely bitter taste, perceptible even in highly dilute 
(i to 700,000) solution. Permanent in the air. Soluble at 15° C. 



468 A TEXT-BOOK OF MATERIA MEDICA. 

(59° F.) in 6700 parts of water, in no parts of alcohol, in 2500 
parts of boiling water, and in 12 parts of boiling alcohol; also 
soluble in 7 parts of chloroform, but almost insoluble in ether. 

Dose. — eVTV g^^in (0.001-0.004 Gm.). 

Strychnine enters into the following preparations : 

FSrri et Strychninae Citras. 

Syrupus FSrri, Quininae et Strychninae Phosphatum. (See Ferrum, page 
185.) 

Strychninae Sulphas— Strychninae Sulphatis— 
Strychnine Sulphate. U.S.I*. 

Description and Properties. — Colorless or white, prismatic 
crystals, odorless, and having an intensely bitter taste, perceptible 
even in highly dilute (i in 700,000) solution. Efflorescent in dry 
air. Soluble at 15° C. (59° F.) in 50 parts of water and in 109 
parts of alcohol ; also soluble in 2 parts of boiling water and 8.5 
parts of boiling alcohol. Almost insoluble in ether. 

Dose. — i^-Yt gi"ain (0.001-0.004 Gm.). 

Antagonists and Incompatibles. — Chloral, tobacco, potassium 
bromide, chloroform, and ether antagonize the toxic action of 
strychnine, the first-named drug being the best antagonist. Phy- 
sostigma, curare, conium, opium, hydrastine, and oil of chamomile 
are also antagonistic. 

The incompatibles are tannic acid, bromides, iodides, and chlo- 
rides. 

Synergists. — The motor excitants, ergot, ustilago, electricity, 
and cold. 

Physiological Action. — Since strychnine fully represents the 
physiological action of nux vomica, that of the former is here 
given. 

Externally and Locally. — In large doses strychnine acts as an 
antiseptic, but on account of its poisonous nature it is too 
dangerous to be serviceable. When applied locally to unicel- 
lular organisms, in very dilute solutions, the drug acts as a 
stimulant, increasing their movements. In slightly more con- 
centrated solutions strychnine arrests these movements and de- 
stroys life. 

Internally. — Digestive System. — Strychnine is an excellent sto- 
machic tonic, improving the appetite greatly and aiding diges- 
tion. By its favorable action upon the mucous membrane of 
the stomach it facilitates the secretion of gastric juice, and by 



MOTOR EXCITANTS. 



469 



imparting tone to the muscular walls of the intestines it increases 
peristalsis and allays constipation when due to lack of muscular 
tone. 

Probably the favorable action which strychnine exerts on the 
stomach is due to its stimulation of the nerve centers which preside 
over the vascularity and the secretory cells, thus rendering the 
digestive process more perfect. 

Circulatory System. — Strychnine stimulates the heart by its 
action on the cardiac muscle. Pharmacologically the pulse should 





Fig. 5. — Diagram showing how strychnine affects the motor and reflex mechanisms: A, motor 
and sensory mechanisms ; B, cerebral motor areas ; C, sensory center ; D, motor tract ; E, sensory 
tract; F, spinal motor areas ; G, switch center, or mechanism for conveying impressions from sensory 
to motor nerves ; H, sensory nerve ; /, motor nerve ; K, muscle. 



be decreased, owing to the stimulating action of the vagus center 
in the medulla. But this depressing influence seems to be over- 
come by the direct stimulating action upon the heart muscle. In 
therapeutic doses it is generally held that the pulse is slightly 
increased. In poisonous doses the pulse is slowed and weakened, 
owing to over-stimulation of both the heart muscle and the motor 
mechanism. 

Nervous System. — Strychnine enormously increases the excita- 



470 A TEXT-BOOK OF MA TERIA MEDICA. 

bility of the central nervous axis. The first symptoms of the drug 
are an increase in all the reflexes. This has been shown by Hel- 
ton and Muirhead to be due to a diminished resistance between 
the cells in the anterior and posterior horns of the cord. Nor- 
mally, stimulation of a certain part — as, for instance, of a frog's 
toe — simply occasions a movement of the part stimulated, no 
other point being affected. But under the influence of strychnine 
the slightest stimulation is often sufficient to throw the whole 
body into tetanic contraction, showing that not only is the resist- 
ance in the normal path followed by lessened reflexes, but that 
resistance in all directions is diminished to such an extent that 
the impulse affects the entire muscular system. This action on 
the reflexes is solely on the cord. In fact, the action of strych- 
nine upon the cord seems to be more powerful than upon any 
other portion of the central nervous axis. That the upper brain 
centers also are stimulated is shown by the fact that all men- 
tal processes are rendered more acute ; and the same is true of 
special senses. Very large doses of strychnine cause paralysis 
o( the motor apparatus, with loss of voluntary movement — due 
to over-stimulation of the reflex centers in the cord, producing 
exhaustion. 

It must be remembered that strychnine does not increase the 
automatic powers, but simply augments their susceptibility to 
external stimulation. 

Strychnine greatly intensifies reflex excitability, so that in 
strychnine-poisoning a bright light, a sound, a jar of the bed, or 
touching the skin may reflexly produce a convulsive seizure. 

Respiratory System.— By the stimulating effect of strychnine 
upon the respiratory center in the medulla the breathing is ren- 
dered quicker and deeper. Owing to the tetanic contractions of 
the respiratory muscles, under poisonous doses the breathing is 
greatly interrupted, and the patient may become asphyxiated. At 
length, the respiratory muscles becoming completely exhausted, 
death ensues, although the principal cause of collapse is paralysis 
of the respiratory centre. It is to be noted that the heart con- 
tinues to beat for some time after respiration has ceased. 

Absorption and Elimination. — Strychnine is rapidly absorbed 
and slowly excreted, and consequently accumulates in the system. 
It is eliminated mainly by the kidneys, appearing in the urine as 
strychnine, and is also slightly excreted by the skin and the salivary 
glands. 



PLATE I. 





Strychnine-poisoning. 



MOTOR EXCITANTS. 471 

Temperature. — Under therapeutic doses the temperature is 
shghtly raised, owing to increased oxidation, as shown by the 
increase of urea and carbon dioxide ehminated and of oxygen 
taken in. During the tetanic convulsions the body temperature 
is markedly raised, though it is generally greatly reduced during 
the stage of exhaustion immediately preceding death. 

Eye. — The general nervous stimulation produced by strychnine 
affects the mechanism of the eye, vision, as has been remarked, 
being rendered more acute. 

Uterus. — Strychnine exerts some influence upon the muscular 
uterine tissues and assists the catamenia. 

Untoward Action. — Certain peculiar manifestations, having but 
slight resemblance, or none whatever, to the characteristic symp- 
toms of poisoning, have followed the ingestion of small doses of 
strychnine. Some observers have noted the presence of a scarla- 
tiniform eruption ; cramps followed by perspiration, resembling in 
some respects the tertian type of intermittent fever ; redness of the 
eyes ; formication ; a peculiar heaviness and stiffness of the limbs ; 
persistent and painful priapism ; and gastric uneasiness. 

Children are exceedingly susceptible to the untoward effects 
of strychnine, Its administration requiring extreme caution. The 
author, however, is familiar with a case resulting beneficially in 
the practice of Dr. Alfred C. Cotton of Chicago, when -^-^ grain 
(0.036 Gm.) of strychnine sulphate was given hypodermically every 
three hours to a child three years of age seriously ill with pneu- 
monia. Such heroic dosage is nevertheless seldom advisable. 

Poisoning. — As is the case with other active poisons, strychnine 
in lethal doses produces varying effects dependent upon tempera- 
ment, idiosyncrasy, and physiological conditions. Generally speak- 
ing, the absorption of large doses is followed by rigidity of the 
lower maxillary, dilatation of the pupils, increased action of the 
reflexes, and spasmodic and distressing muscular contraction, affect- 
ing the extensors particularly. Finally, the respiratory muscles 
are affected with tetanic rigidity, death resulting from asphyxia. 
In many cases the earliest symptoms of poisoning are restlessness 
and anxiety, twitching of the muscles, and stiffness of the neck. 
Spinal convulsions are manife'sted, the patient assuming the position 
of opisthotonos, so that he rests upon his head and his heels. 

The slighte"st external irritation at this stage, even a movement 
of the bed-clothes, is sufficient to cause a recurrence of convulsions. 
Notwithstanding these grave symptoms, the mind remains unaf- 



472 A TEXT-BOOK OF MA TERIA MEDIC A. 

fected until carbonic-acid poisoning sets in, and the stomach is 
usually retentive. Accompanying the usual symptoms in cases 
of acute poisoning is the distortion of the features, which assume 
a ghastly grin {risus sai^donicus). The action upon the genito- 
urinary tract is quite marked, involuntary ejaculations of semen 
frequently taking place, together with incontinence of urine. 

The earlier paroxysms attendant upon the effects of the drug 
are seldom fatal, but in the intervals of repose the patient's mind 
is oppressed with a sense of impending dissolution, intensified by 
each renewed access of spasm and increasing severity of pain. 

Treatment of Poisoning. — Emetics and cleansing of the stomach 
are naturally of the first importance. Animal charcoal and tannic 
acid should be freely administered, while copious anal injections 
containing potassium bromide and chloral are often efficacious in 
relieving the spasms. 

Amyl-nitrite inhalations may prove serviceable as an aid to 
restore failing respiration when artificial means are required. 

The chemical antidote to strychnine is tannin, which should be 
given immediately in the form of an aqueous solution, the stomach 
being subsequently well cleansed. Catheterism should be per- 
formed frequently to favor elimination, care being taken not to 
create a recurrence of spasm and consequent convulsions, which 
may often be obviated by the inhalation of chloroform or ether in 
sufficient quantities to produce complete anesthesia. The bowels 
should be evacuated, croton oil per rectum being an efficient 
agent. 

As has been stated, potassium bromide, chloral, and physostig- 
mine are serviceable physiological antidotes. Opium and conium 
may also be used to counteract the effects of the drug. Paralde- 
hyde has been preferred to chloral, and tobacco and alcohol have 
been suggested, even in heroic doses, should the malady refuse to 
yield to other remedial agents. 

Therapeutics. — Externally and Locally. — M. Mackenzie has rec- 
ommended strychnine in ^r-re g^^^^ (0.0027-0.004 Gm.) doses in 
some harmless and inert medium as an insufflation in anosmia, 
and lint saturated with the tincture of nux vomica and appHed to 
the perineum has been advised in incontinence of urijie. 

Internally. — There is no more efficient remedy in atonic dys- 
pepsia than nux vomica or strychnine. Both possess all the prop- 
erties of the simple bitters, besides stimulating the nerve-centers, 
rendering the co-ordination of the digestive process more perfect 



MOTOR EXCITANTS. 473 

and enabling the stomach to respond more readily when the stim- 
ulus of food is applied to it. 

The gastric catarrli of inebriates is especially benefited by this 
drug, which also serves a useful purpose in the vomiting of preg- 
nancy and ^ phthisis. 

Its tonic action upon the intestinal muscles renders it an invalu- 
able remedy in Jiabitital constipation, atonic diarrhea, and prolapsus 
of the rectum, the latter condition being frequently observed in 
children and aged persons, especially the latter, who are often men- 
tally depressed by this infirmity, and who are relieved by strych- 
nine, either given internally or injected as a solution into the sub- 
cutaneous tissue of the rectum, toning up the muscles and at the 
same time stimulating the cerebrum, relieving the melancholia and 
inspiring the patient with hope. 

Strychnine is a most valuable cardiac tonic, having a marked 
action on the cardiac nervous system and also upon the heart 
muscle. In pne^imonia, typhoid fever, and other diseases accom- 
panied by dyspnea and feeble heart-action, no more valuable drug 
can be employed. It differs from alcohol and other cardiac stimu- 
lants in that its use is not followed by depression. The hypoder- 
mic injection of full doses of strychnine ordinarily renders the 
pulse full and strong, even when it is scarcely perceptible and 
death appears imminent. Many clinicians have undoubtedly tided 
pneumonic patients over the critical period by the heroic use of 
strychnine, when, but for the drug, they would have died. The 
functional irregularity of the hearfs action accompanying hysteria, 
hypochondriasis, and pregnancy is greatly relieved by moderate 
doses of tincture of nux vomica. 

As a tonic in chlorosis and anemia strychnine is an esteemed rem- 
edy, being, in the author's opinion, the best we possess in general 
efficiency. It improves the appetite, prevents putrefactive changes, 
and aids digestion, thereby enabling the patient to partake of and 
assimilate more nutriment. It also increases the force of the heart, 
quickens the circulation, and raises arterial tension, nourishing all 
parts of the body and rendering the condition more favorable for 
oxidation in the tissues and for the removal of waste products. 
The amount of urine is increased, constipation is relieved, and thus 
ehmination of these products facilitated. 

Oxidation is further enhanced by the increased respiratory 
movements, rendering the blood richer in oxygen and increasing 
the number of the red corpuscles. 



474 A TEXT-BOOK OF MA TERIA MEDICA. 

The potent action of strychnine upon the nervous system stimu- 
lates the spinal cord, giving the patient greater strength, and, by 
invigorating the brain, animating him with cheerfulness and con- 
fidence and a disposal to exercise. 

Strychnine, then, is at once a gastric, vascular, nervous, mus- 
cular, and respiratory tonic, being an invaluable remedy in debility 
from any cause. 

In bi^onchial and neurotic asthma, as well as in many forms of 
neuralgia, particularly the visceral variety, the drug is an efficient 
remedy. In broncliitis also, and to relieve the coughs of neurotic 
origin, it is of great value. 

Paralysis of spinal origin — paraplegia, etc. — and hemiplegia pre- 
vious to degeneration, with complete relaxation of the muscles, are 
benefited by strychnine, although in the latter affection it is of little 
if any value in recent cases or when the muscles do not respond to 
the electric current. 

The sphincters of the body, although belonging to the unstriped 
muscles, are more or less under the control of the will ; still, when 
there is an atonic condition of these structures, as in incontinence 
of urine, due to weakness of the sphincter, strychnine is a very 
powerful remedy. For the same remedial properties it is equally 
valuable in retentioji of urine when the detrusor muscle is too weak 
to empty the bladder. 

Probably no other drug equals strychnine in diphtheritic paraly- 
sis, the form of the disease most benefited by the remedy. It is of 
use, however, in all varieties oi functional paralysis^ such as those 
resulting from hysteria, mental emotion, alcoholism, venereal ex- 
cesses, the abuse of opium, lead-poisoning, gout, rheumatism^ 
concussion of the spinal marrow, etc. 

Jewell claims that strychnine has caused an improvement in 
myelitis after the failure of other remedies. 

The weak and semi-paralyitic condition sometimes induced by 
bromides is improved by strychnine. 

The drug has found a few supporters in the treatment of tetanus, 
epilepsy, tic douloureux, and chorea, though it has not been gener- 
ally adopted as a remedy in these diseases. 

Strychnine is exceedingly efficacious in amaurosis due to exces- 
sive use of alcohol or tobacco, being also valuable in paresis of the 
ocular muscles. Night-blindness is also greatly benefited by this 
drug. 

It is of undoubted merit in delirium tremens, as well as in pre- 



MOTOR EXCITANTS. 475 

venting- the usual effects of alcoholic intoxication ; in fact, the drug 
is one of the best remedies in the treatment of alcoholism, the 
strychnine nitrate being usually employed, hypodermically. Ac- 
cording to the best authorities on dipsomania, strychnine seems to 
be a true antagonist to the untoward action of alcohol, and it is 
probably the important constituent of the numerous " cures " for 
the alcohol habit. 

No less valuable is strychnine in the treatment of acute poisoning 
by chloral, morphine, and physostigmine. 

As an aphrodisiac it is of unquestioned value in fimctional sper- 
matorrhea, and it is thought to produce contractions of the gravid 
uterus and cause abortion or premature delivery. When a predis- 
position to post-partum hemorrhage exists, the administration of 
strychnine may prove of great service. 

Finally, strychnine has been highly recommended in the nigJit- 
sweats of phthisis and in diabetes mellitiis. 

Contraindications. — Strychnine is contraindicated or of no 
value in true voluntary muscular paralysis, where the region is 
directly under the control of the cerebrum. It is also contraindi- 
cated in acute inflammatory conditions of the spinal cord and 
excessive reflex irritability. 

Administration. — The extract of nux vomica, the tincture, the 
fluid extract, or the alkaloid strychnine may be given and gradually 
increased, a tolerance by the system being rapidly estabHshed. The 
salts of strychnine are preferable to other preparations, the crude 
drug and its preparations vaiying greatly in strength, 10 minims 
(0.6 Cc.) of one tincture sometimes containing as large a percent- 
age of strychnine as 20 minims (1.2 Cc.) of another. 

The drug should be cautiously administered to children, the 
initial dose for a child five or six years of age not exceeding 
TTo gi'ain (0.0006 Gm.). 

In using strychnine hypodermically the soluble hypodermic 
tablets should be freshly dissolved in distilled water. 

The solutions of strychnine and of the other alkaloids should 
not be kept in stock, as they become contaminated with microscopic 
plants. 

Cocculus— Coccull— Cocculus Indicus. 

(Fish Berry.) 
Orig-in. — The dried fruit of Anannrta CoccidtLS Wright and 
Arnott, a climbing shrub in Eastern India, native to the Malabar 
coast. 



476 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — A globular, kidney-shaped, one- 
celled berry, about \ inch (6 Mm.) in diameter and f inch (lo Mm.) 
in length, blackish-brown and wrinkled. The seed is very bitter, 
but the pericarp is tasteless. The chief constituent is picrotoxin, 
the poisonous principle contained in the kernel and first isolated 
by Boullay in 1819. 

The crude drug is not used internally. 

Unofficial Preparations. 

Tinctura C6cculi — Tincturae C6cculi — Tincture of Cocculus. — Dose, 2-20 
minims (0.12-1.2 Cc). 

Extractum C6cculi Fluidum— Extracti C6cculi Fluidi— Fluid Extract of 
Cocculus. — Dose, 1-3 minims (0.06-0.2 Co.). 

Picrotoxinum— Picrotoxini— Picrotoxin. 77. 8. 1", 

Origin. — A neutral principle obtained from the seed of Ana- 
mirta paniculata Colebrooke. 

Description and Properties. — Colorless, flexible, shining, pris- 
matic crystals, or a micro-crystalline powder, odorless and having 
a very bitter taste ; permanent in the air. Soluble in 240 parts of 
water and in 9 parts of alcohol. 

Dose. — ^^sV grain (0.001-0.002 Gm.). 

Antagonists and Incompatibles. — Chloral, the motor depres- 
sants, acetic acid, and the anesthetics antagonize the effects of 
picrotoxin. 

Synergists. — All the motor excitants. 

Physiological Action. — Externally and Locally. — It is a power- 
ful parasiticide, being very destructive to lower forms of animal life. 

Internally. — Digestive System. — In small medicinal doses its 
action is similar to that of strychnine. 

Circulatory System, — Its general effects do not differ essentially 
from those of strychnine. 

Nervous System. — Picrotoxin differs somewhat from strychnine 
in its action upon the nervous system, poisonous doses producing 
epileptiform convulsions and spasms of the flexor muscles, alter- 
nating from tonic to clonic, whereas the spasms induced by 
strychnine affect principally the extensor muscles and are tetanic 
in character. The brain also is differently affected — toxic doses 
resulting in stupor, delirium, coma, and complete insensibility. 

Respiratory System. — Picrotoxin tends to stimulate the respira- 
tory center, its general influence being analogous to that of strych- 
nine. 



MOTOR EXCITANTS. 477 

Absorptio7t and Elimination. — The drug is rapidly absorbed, and, 
as in the case of strychnine, is ehminated chiefly by the kidneys, 
the sweat being also a channel of excretion, since cocculus, even 
more than strychnine, acts as a powerful diaphoretic. 

Temperature. — No special action has been noted, though the 
temperature may be raised slightly during the convulsive period. 

Eye. — The pupils are dilated during the tonic and contracted 
during the clonic spasms. An ophthalmoscopic examination shows 
a marked hyperemia of the ocular fundus. 

Poisoning. — The drug produces muscular twitchings, incoordi- 
nation, great restlessness, tonic convulsions, with opisthotonos or 
emprosthotonos, alternating with clonic spasms and succeeded by 
paralysis, delirium, and coma. The respiratory apparatus is affected 
as in strychnine-poisoning. 

The symptoms are very similar to those of an epileptic seizure, 
and the post-mortem lesions are analogous to those of epilepsy. 

Treatment of Poisoning. — This is identical with that prescribed 
in cases of poisoning by strychnine. 

Therapeutics. — Externally and Locally. — The most important 
use of COCCULUS locally is in the treatment oi parasitic and skin dis- 
eases, an ointment of picrotoxin — lo grains to i ounce (0.6-32.0 
Gm.) — being employed for this purpose. Caution should be used 
in applying it to abraded surfaces lest poisoning result. 

The DECOCTION or tincture of cocculus Indicus is very effective 
in destroying parasitic vermin infesting the head and body. 

Internally. — Picrotoxin has been used, although less success- 
fully, for many diseases treated with strychnine, especially paralysis 
of the extremities and of the sphincters. 

Planat has highly recommended the use of cocculus in epilepsy ; 
the best results in this disease, however, are obtained in the treat- 
ment of the nocturnal variety. The same authority advised the 
employment of the drug in chorea, infantile eclampsia, and chronic 
spasm of the limbs. 

Bartholow suggested that the drug, like strychnine, would prove 
valuable in intestinal torpor. 

Bokai has advocated its use in opium-poisoning. 

Unquestionably, its most valuable action is in controlling the 
night-szueats of phthisis. Mirrell, who first used it for this purpose, 
reported but one failure in twenty. Gubler has succeeded in 
greatly benefiting glosso-labio-laryngeal paralysis by the hypo- 
dermic injection of -^ grain (0.00 1 Gm.) of picrotoxin. 



478 A TEXT-BOOK OF MATERIA MEDICA. 

Dysmenorrhea and migraine occurring at the menstrual period 
are said to be greatly relieved by this drug. Even sero-purulent 
leucorrhea^ it is claimed, has derived benefit from the administration 
of some preparation of cocculus. 

Contraindications. — Similar to those for strychnine. 

Administration. — The picrotoxin is far preferable to other 
preparations of cocculus, both for external and internal use. It 
should be very cautiously administered, however. 

Ergota—Erg5tae— Ergot. TJ. S. F. 

(Ergot of Rye.) 

Origin. — The sclerotinum of Claviceps purpurea (Fries) Tulasne 
(Fungi), replacing the grain of rye, Secale cereale L. Most of the 
commercial article comes from Spain and Russia. 

Description and Properties. — Somewhat fusiform, obtusely 
triangular, usually curved, about f to i^ inches (2-3 Cm.) long and 
-|- inch (3 Mm.) thick ; three-furrowed, obtuse at both ends, purplish- 
black, internally whitish, with some purplish striae, breaking with a 
short fracture ; odor peculiar, heavy, increased by trituration with 
potassium or sodium hydrate T. S. ; taste oily and disagreeable. 
Old ergot, which breaks with a sharp snap, is almost or entirely 
devoid of a pinkish tinge in the fracture, is hard and brittle between 
the teeth, and comparatively odorless and tasteless — should be 
rejected. 

Ergot should be but moderately dried and preserved in a close 
vessel, with a few drops of chloroform added from time to time to 
prevent the development of insects. When more than one year 
old it is unfit for use. 

The active constituents of ergot are not definitely ascertained. 
It contains, however, an acid soluble in water and variously termed 
sclerotinic, ergotinic, and ergotic acid, and another, soluble in alka- 
lies, known as sphacelic acid. Both of these acids possess ecbolic 
properties. Ergot also contains a principle known as coritutin, and 
30 per cent, of a yellow non-drying saponifiable fixed oil, besides 
proteids, sugar, tannin, and ash. The commercial ergotin is merely 
a purified aqueous extract of ergot. 

Dose. — 5-60 grains (0.30-4.0 Gm.). 

Official Preparations. 

Extr^ctum Ergotae— Extract! Ergotae— Extract of Ergot.— Z>^i^, 2-10 grains 
(0.12-0.06 Gm.). 



MOTOR EXCITANTS. 479 

Extractum Ergotse Fluidum — Extract! Ergotae Fluidi — Fluid Extract of 
Ergot. — Dose, 15-60 minims (1.0-4.0 Cc). 

Vinum Ergotae — Vini Ergotae — Wine of Ergot. — Dose, 1-3 fluidrachms (4.0- 
12.0 Cc). 

Unofficial Preparations. 

Tinctura Ergotae — Tincturae Ergotae — Tincture of Ergot. — Dose, \-2 fluid- 
drachms (2,0-8.0 Cc). 

Ergotin (Bonjean's). — Dose, 2-8 grains (0.012-0.5 Gm.). 

Antag-onists and Incompatibles. — The cardiac and motor 
depressants antagonize the action of ergot. Caustic alkalies and 
metallic salts are chemically incompatible. 

Synergists. — Its action upon the circulation is aided by digitalis 
and belladonna ; upon the nervous system by strychnine ; while 
ustilago, hydrastine, gossypium, and the emmenagogues enhance 
its influence upon the uterus. 

Physiological Action. — Exteinially and Locally. — Ergot has no 
distinctive action upon the skin, but upon mucous membranes its 
influence is that of an astringent, possessing hemostatic properties. 

Internally. — Digestive System. — In large doses it is a gastro- 
intestinal irritant, occasioning considerable heat and dryness of the 
throat, accompanied by thirst and succeeded by pain in the stom- 
ach and bowels, vomiting, and occasionally purging, with violent 
peristalsis, although constipation is the commoner sequence. 

Circulatory System. — Repeated medicinal doses increase the 
blood-pressure, although rendering the pulse slower and smaller — 
the result primarily of stimulation of the vaso-motor center, fol- 
lowed by peripheral action, causing a tonic contraction of the 
small unstriped muscle fibers. 

A poisonous dose lowers arterial tension, causing the pulse to 
beat faster and softer — an effect due to exhaustion from over- 
stimulation or to direct depressant action upon the heart-muscle. 
It is claimed by competent authority that there is no active and 
actual contraction of the arteries, the result of stimulation of the 
vaso-motor system, but that the arteries contract because of the 
fulness of the veins, there not being sufficient blood to fill both 
systems, marked arterial anemia consequently resulting. It must 
be admitted that the true physiological action upon the circulatory 
system is not yet generally understood, being still sub judice, since 
equally competent pharm^acologists maintain that the arterial pres- 
sure is increased as explained above. 

It is an undisputed fact, however, that the cardiac muscle is 



480 A TEXT-BOOK OF MATERIA MEDIC A. 

actually contracted by ergot. Indeed, Willebrand claims that " the 
normal or hypertrophied heart so contracts under the action of 
ergot that the difference in size is appreciable by percussion " 
(Bartholow). 

If any changes are produced by this drug in the composition 
of the blood, they have not been ascertained. 

Nervous System. — Medicinal doses have no especial action, 
though excessive doses sometimes depress the sensory mechanism, 
producing general cutaneous anesthesia. 

The action of toxic doses on the nervous system will be 
described under " Poisoning." 

Respiratory System. — Medicinal doses produce no particular 
effect. Large doses depress the respiratory center, rendering the 
breathing shallow. This action is manifest from the first, there 
being no primary stimulation of the respiration. Death from an 
overdose of ergot usually results from paralysis of the respiratory 
center. 

Absorption and Elimination. — The active constituents of ergot 
are rapidly absorbed into the blood, and are eHminated principally 
by the kidneys, increasing the urinary flow. 

Temperature. — No special action has been observed. 

Eye. — The caliber of the retinal and nutrient opticus blood- 
vessels is reduced, resulting in marked pallor of the disk, transitory 
amblyopia, and papillary anemia. 

Uterus. — Probably the most important action of ergot is upon 
this organ. It produces in full doses tetanic, tonic contraction of 
the uterine muscle, the uterus becoming hard and pale, and forcing 
the blood out of the uterine arterioles. The organ is more sensi- 
tive to the action of the drug during pregnancy. 

The precise manner in which ergot affects the uterus is still 
a matter of discussion. It is fairly demonstrated, however, that 
the drug acts both centrally and peripherally, owing to its different 
constituents, cornutin acting centrally and sclerotinic acid periph- 
erally. The drug causes a contraction of involuntary muscles 
throughout the body. 

It is doubtful if any drug in our Materia Medica has been more 
carefully studied than ergot, and, if opinions differ widely as to its 
modus operandi, it is because we have to deal with a very complex 
substance, the nature, and even the number, of whose constituents 
are as yet inadequately known. Many principles of the drug are 
unstable and variable in their action, certain preparations differing 



MOTOR EXCITANTS. 4S1 

decidedly from others in their influence, as, for instance, Tanret's 
ergotinine, which has no effect upon the uterus. Bonjean's ergotin 
is a powerful ecbolic, and has a marked action, moreover, upon the 
vascular system, whereas Wigger's ergotin is inert. 

Untozvard Action. — In addition to the gastro-intestinal disturb- 
ances already described, there are occasionally produced headache, 
mental confusion, dizziness, a feeling of chilliness, muscular weak- 
ness, dilatation of pupils, and glimmering before the eyes. 

Poisoning. — There are two varieties of ergot-poisoning, acute 
and chronic. Under the administration of immoderate doses pecu- 
Har symptoms appear, known collectively as acute ergotism. Rest- 
lessness, mental worry, headache, tinnitus aurium, dilatation of the 
pupils, pallor and coldness of the skin, and other effects are present. 
At times cutaneous anesthesia is manifest or general formication. 
Epileptiform spasms, great reduction of respiration and temperature, 
may occur, while obstruction of cardiac movements, with sudden 
nausea and violent vomiting, and other alarming manifestations, 
attest the untoward properties of the drug. 

Chronic ergotism is confined chiefly to Europe, where ergotized 
rye is used in bread-making. The disease is marked by convulsive 
or gangrenous conditions. 

The first variety, the convulsive, is characterized by paroxysmal 
spasms of the flexor muscles, which later become continuous, re- 
sulting in opisthotonos or emprosthotonos. There is dimness of 
vision, while an increasing intensity of symptoms develops affection 
of other special senses, those of hearing and smell being either 
impaired or temporarily lost. Violent abdominal cramps also occur, 
together with painful dyspnea, death resulting from asphyxia or 
coma. 

The second (gangrenous) form is signahzed by severity of local 
phenomena, profound dyscrasia, formication or cutaneous anes- 
thesia, impairment of special senses, and numbness of the muscles 
or extremities, followed by sloughing or atrophy of the diseased 
parts and mummification or dry or moist gangrene. 

Fatal results of chronic ergotism are usually traceable to the 
convulsions, although moist or dry gangrene may in certain cases 
produce death. 

Treatment of Poisoning. — Symptoms of acute poisoning may be 
alleviated by hot baths and the administration of tannic acid and 
cardiac stimulants. For the treatment of chronic ergotism hygienic 
measures and symptomatic remedies are indicated. 

31 



482 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally and Locally. — Ergot, in an impalpa- 
ble powder, has been recommended as an external application in 
the treatment of carbuncle and epithelioma. In the form of lozenges 
or diluted fluid extract the drug has been employed in acute 
pharyngitis. The hypodermic injections of ergotin are valua- 
ble in 7iasal hypertrophies, prolapsus of the rectum, hemorrhoids, 
enlargement of the prostate gland, aneurysm, varicocele, and vari- 
cose veins. 

Internally. — The most important medical use of ergot is to 
promote uterine contractions in labor. The preponderance of 
testimony among the most experienced obstetricians is in favor of 
its use only after the expulsion of the uterine contents. This is a 
rule, however, which cannot be invariably followed. While the 
employment of the drug is contraindicated in the first stage of 
labor, it may be safely employed during the second stage, when 
there is uterine inertia, provided all the parts be in a normal 
condition and there exists no mechanical impediment to the rapid 
delivery of the child. Ergot is of service also when the placenta 
is retained owing to inefficient and feeble uterine contractions. 

With these exceptions it is customary — and the author concurs 
in the procedure — to delay the administration of the drug until the 
expulsion of the placenta, when a full dose of the fluid extract is 
given, or ergotin hypodermically. When ergot is administered 
during the second stage of labor, it should be given in small doses, 
so as to promote intermittent rather than continuous contractions 
of the uterus. No drug possesses so energetic and prompt an 
action as ergot in post-partum and uterine hemorrhage. It is an 
exceedingly efficacious remedy also in subinvohition and in 2iterine 
fibroids and polypi. 

The accompanying diagrams will illustrate the control of hemor- 
rhage through the contraction of the uterine muscle and arterioles, 
and the influence of ergot upon submucous fibroid tumors by 
mechanical compression and consequent diminution of their blood- 
supply. It is obvious that the location of a subperitoneal tumor 
is such that the drug cannot influence its growth as it can a sub- 
mucous fibroid. 

This remedy is also extremely useful in the treatment of ple- 
thoric amenorrhea, congestive dysmenorrhea, menorrhagia, chronic 
metritis, etc. 

Dilatation of the cardiac cavities Avithout valvular lesion is 
much improved by the administration of ergot ; the remedy has 



MOTOR EXCITANTS. 



483 



also been employed with considerable success in chronic diarrhea 
and dysentery. 

Incontinence of nrine — depending either upon enlarged prostate, 
irritability, or a paretic or paralytic condition of the bladder — is 





Y\Q,. 6. — Diagram showing how ergot reduces 
-uterine hemorrhage: A, uterine muscle; B, B, 
arteries. 



Fig. 7. — Diagram showing how ergot reduces 
the size of a submucous fibroid, but has no effect 
upon a subperitoneal fibroid : A, uterine muscle ; 
B, subperitoneal fibroid ; C, submucous fibroid ; 
D, D, arteries. 



greatly relieved by this remedy. The atonic form of spermatorrhea 
is palliated or cured by ergot. 

The drug is of value also in cerebral hyperemia and consequent 
mania, as well as in cerebrospinal meningitis, congestion of the 
spine, myelitis, and congestive headaches. 

Ergot has been highly recommended, notably by Dr. J. M. Da 
Costa, in diabetes insipidus, and by such authorities as Heltzmann 
and D'Enslow in prurigo, eiythema, urticaria, and acne rosacea. 

Owing to the peculiar action of ergot upon unstriped muscular 
fiber it is a valuable drug in various forms of hemorrhage. 

The diseases mentioned as being favorably influenced by the 
local application yield as readily perhaps to the internal administra- 
tion of ergot. 

Finally, this remedy has met with some success in the treatment 
of leucorrhea, galactorrhea, hypostatic congestion of the lungs, zvhoop- 
ing cough, the different varieties of purpura, colliquative sweats, 
splenic enlaigements, and exophthalmic goiter. 

Contraindications. — During the first stage of labor and in 
■cerebral or spinal anemia. 

Administration. — For its action upon the uterus a valuable 



484 A TEXT-BOOK OF MATERIA MEDIC A. 

fluid extract is the best preparation as an internal remedy ; for 
hypodermic use the aqueous extract (ergotin) or some of the 
non-alcoholic fluid preparations manufactured by certain reliable 
pharmacists for this particular purpose, should be employed. 
Ergotin may be incorporated in suppositories when for any reason 
it is desirable to administer the drug per rcctiun. 

Gossypii Radicis Cortex— Gossypii Radicis Corticis— 
Cotton Root Bark. TI. S. P. 

Origin. — The bark of the root of Gossypiuin herbaceuin L. and 
of other species of the genus, indigenous in the tropical and sub- 
tropical regions of Asia and Africa. The plant has been cultivated 
in the United States and other countries from a very early period, 
many characteristic varieties having been produced. 

Description and Properties. — It occurs in thin, flexible bands 
or quilled pieces, the outer surface brownish-yellow, with slight 
longitudinal ridges or meshes, small, black circular dots, or shorty 
transverse lines, and dull, brownish-orange patches, from the abra- 
sion of the thin cork ; inner surface whitish, of a silky lustre, finely 
striate ; bast-fibers long, tough, and separable into papery layers ; 
inodorous ; taste very sHghtly acrid and faintly astringent. 

It contains a fixed oil, a small quantity of tannin, sugar, and 
starch, a yellow resin, and, in the fresh bark, a pale-yellow chromo- 
gene, soluble in alcohol, which on exposure to air becomes red 
and resinous. 

Dose. — 15-60 grains (1.04-4.0 Gm.). 

Official Preparation. 
Extractum Gossj^pii RSdicis Fluidum — ExtrScti Gossypii RSdicis Fluidi — 
Fluid Extract of Cotton Root ^z.x)ii.—Dose, \-\ fluidrachm (1.8-3.7 Cc). 

Antag-onists and Incompatibles. — The same as for ergot. 

Synergists. — Ergot and its synergists. 

Physiological Action. — Identical with that of ergot, but infe- 
rior in certainty of action. 

Therapeutics. — Cotton root bark is employed only for its action 
upon the uterine system, in which respect it is identical with ergot. 
An exception may possibly be in its use in the treatment of subin- 
volution and tumors of the uterus, in which cases it is less efficient 
than ergot. 

Contraindications. — The same as for ergot. 

Administration. — The fluid extract only should be employed. 



MOTOR EXCITANTS. 485 

Hydrastis— Hydrastis— Hydrastis. TJ. S. J*. 

(Golden Seal.) 

Orig-in. — The rhizome and roots of Hydrastis Canadensis L., a 
perennial native to Canada and the United States east of the Mis- 
sissippi, growing- in rich woodlands and in the Southern States, 
confined to mountainous districts. 

Description and Properties. — The rhizome is from i to 2 
inches (2-5 Cm.) long and about \ inch (6 Mm.) thick, oblique, 
with short branches, somewhat annulate and longitudinally 
wrinkled; externally brownish-gray; fracture short, waxy, red- 
dish-yellow, with a thickish bark, about ten narrow wood-wedges, 
broad medullary rays, and large pith. Roots thin, brittle, with a 
thick yellow bark and subquadrangular woody centre. Odor 
slight, taste bitter. 

The principal constituents are Jiydrasiine (colorless and slightly 
acrid) and berberine (yellow and intensely bitter), the latter alkaloid 
being also found in berberis, Colombo, menispermum, coptis, etc. 
There is a 5^ellow resinoid (hydrastin) on the market which should 
not be confounded with the active alkaloid hydrastine. 

Dose. — The crude drug is not given internally. 

Official Preparations. 

Extractum Hydrastis Fluidum — Extract! Hydrastis Fluidi— Fluid Extract 
of Hydrastis. — Dose, 10-30 minims (0.6-2.0 Cc). 

Glyceritum Hydrastis — Glyceriti Hydrastis — Glycerite of Hydrastis. — Used 
externally. 

Tinctura Hydrastis — Tincturse Hydrastis — Tincture of Hydrastis. — Dose, 
30-60 minims (2.0-4.0 Cc.~). 

Hydrastina — Hydrastinae — Hydrastine (unofficial). — An alkaloid obtained from 
Hydrastis, 

Origin, Description, and Properties. — Colorless, very brilliant, glassy crystals ; taste 
slightly acrid ; fully soluble in ether and chloroform, but freely soluble in water. 

Dose. — j2~i grain (0.002-0.03 Gm.). 

Hydrastinlnae Hydrochloras— Hydrastininse Hydrochloratis — Hydrastinine 
Hydrochlorate. U. S. P. — Origin. — The hydrochlorate of an artificial alkaloid • - 
rived from Hydrastine. 

Description and Properties. — Light-yellow, amorphous granules, or a pale-yellow 
crj'Stalline powder, odorless, and having a bitter, saline taste ; deliquescent on exposure 
to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product 
should be kept in well-stoppered vials. 

Dose. — Y2r\ gjain (0.005-0.03 Gm.). 

Antagonists and Incompatibles. — The alkalies, mineral acids, 
and tannic and other vegetable acids are incompatible with prepara- 
tions of hydrastis. The physiological antagonists are chloral, 
potassium bromide, and the motor depressants. 



486 A TEXT-BOOK OF MATERIA MEDIC A. 

Synergists.— Quinine and the vegetable bitters aid its action 
upon the digestive tract, ergot upon the uterus, and strychnine 
upon the spinal cord. 

Physiological Action. — Exteriially arid Locally. — Hydrastine 
possesses considerable anesthetic action when applied locally, 
and upon the eye its effect is to contract and afterward dilate the 
pupil. 

Internally. — Digestive System. — Its action resembles that of 
strychnine, though excessive doses produce greater gastric dis- 
turbance, almost invariably occasioning vomiting. 

Circulatory System. — Its influence is similar to that of strych- 
nine, but not so powerful. In its effect upon the white blood-cor- 
puscles it resembles quinine, arresting their movements. 

Nervons System. — Here also the action of hydrastis is analogous 
to that of strychnine, although it is much less powerful, while more 
persistent. It differs from its congener, however, in its effect upon 
the sensory nerve-fibers, very large doses impairing their func- 
tional activity, and, when locally applied, produchig anesthesia. 

Respiratory Syste7n. — In its action upon the respiratory system 
it resembles strychnine, differing in no essential particular. 

Absorption and Elimination. — It is slowly absorbed, tending to 
accumulate in the system. It is eliminated chiefly by the kidneys, 
increasing slightly the urinary flow. 

Temperature. — Medicinal doses have no effect ; poisonous doses 
decrease bodily heat. 

Eye. — It has no particular action upon the eye, other than to 
first contract and then dilate the pupil when directly apphed. 

Uterus. — Hydrastine is a feeble oxytocic, affecting the womb in 
a manner similar to, though much less powerful than, ergot. 

Untoward Action. — The untoward manifestations are essentially 
those of poisoning. 

Poisoning. — The symptoms are almost identical with those of 
strychnine. 

Treatment of Poisoning. — The same as that o{ poisoning by 
strychnine. 

Therapeutics. — Externally and Locally. — Hydrastin (the yellow 
resinoid) — in the proportion of 5 grains (0.3 Gm.) to i ounce (30.0 
Cc.) of water, or the fluid extract of hydrastis, 15 to 20 minims 
(1.0-1.2 Cc.) to 4 ounces (118 Cc.) of water — makes an efficient 
injection in gonorrhea. 

Hydrastine (the alkaloid), or, preferably, hydrastine hydro- 



MOTOR EXCITANTS. 487 

CHLORATE — 3 grains (1.2 Gm.) to i ounce (30.0 Cc.) of glycerin — 
affords great relief in certain forms of chrojiic conjunctivitis. 

Hydrastis is a valuable remedy in catarrh of the upper respira- 
tory tract. 

The TI^XTURE — i fluidrachm (3.7 Cc.) to i ounce (30.0 Cc.) of 
water — is a valuable mouth- wash in all indolent and offensive ulcera- 
tions of the month and throat, such as syphilitic and mercurial affec- 
tions, follicidar pharyngitis, etc. 

The FLUID EXTRACT scrves a useful purpose in the local treatment 
of anal fissure and of rectal nicer, vaginal and uterine idcerations, 
and leucorrhea. Indolent idcers anywhere, and chancres and chan- 
croids, are stimulated to a healthier condition by the application of 
this preparation. 

An ointment of hydrastine hydrochlorate, in strength vary- 
ing from 5-30 grains (0.3-2.0 Gm.) to i ounce (32.0 Gm.) of simple 
ointment, affords an efficient local application in acne and seboinliea 
sicca, and the same preparation makes a serviceable dressing for 
idcerated carcinoma and bromidrosis. 

The distilled extract of witch-hazel with hydrastine hydro- 
chlorate is recommended in hyperidrosis. 

Palmer has successfully employed inhalations of a solution of i 
part of the extract to 3 parts of salt water in tnbercidar and simple 
bronchitis.. 

The topical action of hydrastis and its preparations is that of an 
antiseptic and tonic, strengthening the circulation and nutrition, 
rendering the drug peculiarly valuable in diseases of mucous sur- 
faces. 

Internally. — As a remedy for diseased conditions of the stomach 
and bowels it is of much the same value as the vegetable bitters, 
and may be used for the same purposes. 

Hydrastine possesses considerable antiperiodic power, having 
been employed in intermittent fever and chronic malaria, though 
much inferior to quinine, and probably also to arsenic. Its bene- 
ficial action in these conditions is undoubtedly due to its powder to 
increase the functional activity of the liver, this influence also ren- 
dering it valuable in chronic constipation induced by hepatic inac- 
tivity — catarrhal jaundice, too, being frequently relieved by the 
remedy. 

Hydrastine, more especially hydrastine hydrochlorate, acts 
upon the uterus very much like ergot, and has been highly recom- 
mended by well-known authorities in titerine Jiemorrhage and other 



488 A TEXT-BOOK OF MA TERIA MEDICA. 

uterine disorders for which ergot is used. By careful observers, of 
experience with the drug, it is considered superior to ergot in the 
heinoi'i'hage of puberty and the menopause, as well as in congestive 
dysmenorrhea. 

Bossi, who has employed hydrastis Canadensis extensively in 
obstetrical practice, regards it as a valuable hemostatic, believing 
it to be much safer than ergot in the hands of ignorant individuals 
and midwives. 

Koniger has treated hemoptysis successfully with the fluid 
EXTRACT in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several 
times a day. The drug has proved equally beneficial in arresting 
the night-sweats of phthisis, and is an efficient substitute for alco- 
holic stimulants when their use is abandoned. 

Hydrastine hydrochlorate has recently been favorably men- 
tioned as a remedy for epilepsy, strychnine-poisoning, and hydro- 
phobia. 

Contraindications. — The same as for vegetable bitters, strych- 
nine, and ergot. 

Administration. — When taken for its action upon the stomach 
and bowels it should be given before meals ; for its effect on the 
uterus it is best administered in divided doses or the hydrastine 
hydrochlorate hypodermically. 



Rhus Toxicodendron— Rhois Toxicodendri— Rhus 
Toxicodendron. Z7. H, P. 

(Poison Ivy.) 

Origin. — The fresh leaves oi Rhus radicans L., a cUmbing shrub 
indigenous in Canada and the greater part of the United States 
westward to the Rocky Mountains. 

Description and Properties. — Long-petiolate, trifoliate, the lat- 
eral leaflets sessile or nearly so, about 4 inches (10 Cm.) long, 
obliquely ovate, pointed; the terminal leaflets stalked, ovate or 
oval, pointed, with a wedge-shaped or rounded base ; the leaflets 
entire and glabrous or variously notched, coarsely toothed, or lobed, 
more or less downy ; when dry papery and brittle; inodorous ; taste 
somewhat astringent and acrid. The fresh leaves abound in an 
acrid juice which darkens on exposure to air, and when applied to 
the skin produces inflammation and swelling. The leaves should 
therefore not be touched with the bare liands. 

The fresh leaves contain a volatile acid (toxicodendric), which 



MOTOR EXCITANTS. 489 

is almost entirely absent in the dried leaves. In addition to this 
active constituent the leaves contain tannin. 
Dose. — 1-5 grains (0.06-0.3 Gm.). 

U)i official Preparation. 
Tinctura Rhois ToxicodSndri — Tincturse Rhois ToxicodSndri — Tincture of 
Toxicodendron. — Dose, jo"^ minims (0.006-0.12 Cc). Prepared from fresh plants 
— I part of fresh leaves to 2 parts of alcohol. 

Physiolog-ical Action. — Externally and Locally. — The fresh 
leaves of this common plant are extremely irritant to the skin, 
generally acting as a marked vesicant and estabhshing severe local 
inflammation, manifested by acute dermatitis, excessive edema, and 
hyperemia. In many cases these effects are much less pronounced, 
while in certain individuals they are never occasioned by contact 
with or even chewing the leaves. As with poison sumach — Rhtis 
venenata — the toxic influence of the plant derived from local appli- 
cation is apparently more virulent during the period of florescence. 

The inflammation somewhat resembles erysipelas, being rapidly 
diffused and accompanied by a general systemic disturbance, in- 
cluding abdominal pains, nausea, and vomiting, with perhaps diar- 
rhea, diuresis, and serous passages. Profuse diaphoresis and lum- 
bar and articular pains may also result. These symptoms cease 
after about ten days or a fortnight without other sequel than 
desquamation of the affected surface. 

Internally. — The effects of the drug administered internally are 
to cause gastro-intestinal inflammation, with drowsiness and stupor, 
and occasionally delirium and convulsions. Vertigo, nausea, chilli- 
ness, thirst, Vv^eak and irregular cardiac movements, diaphoresis, 
muscular debility, and diuresis are also reported. Dilatation of the 
pupils is also a result of ingestion or internal absorption, and an 
illustration of the virulence of the drug is seen in the fact that even 
air impregnated with exhalations from the leaves may cause epi- 
dermic eruption, while the berries have produced serious symptoms 
in the spinal and cerebral systems, and in an authentic case the 
root has proved notably fatal. 

Treatment of Poisoning. — Many remedies have been used, with 
varying efiflcacy, to allay the toxic effects of the drug. Dermal 
poisoning has been relieved by glycerite of carbolic acid or alkaline 
lotions. In the earlier stage of external irritation warm soapsuds 
and sodium bicarbonate have been successfully applied. Alum- 
curd, ammonia in weak solution, solution of chlorinated soda, and 



490 A TEXT-BOOK OF MA TERIA MEDIC A. 

many other agents have been employed to meet the requirements 
of certain stages of the affection. A solution of cocaine, 4 to 8 
per cent., quickly relieves the cutaneous irritation ; a liquid prepara- 
tion of grindelia robusta makes a grateful application ; while opium, 
coffee, and laxatives would be indicated. 

Therapeutics. — Externally and Locally. — The diluted tincture — 
8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water — has met with 
some favor, as has been stated, in the treatment of sprains, burns^ 
etc. 

In weak solution with alcohol the remedy has been used as 
a stimulating application in cases of sprains^ chilblains, burns ^ 
insect-sting s, etc . 

Internally. — It has been recommended in rheumatic affections of 
fibrons tissues, paralysis, erysipelas, herpes zoster, pemphigus, eczerna^ 
and erythema. 

Dr. Rothrock believes it to be a valuable cerebro-spinal stimu- 
lant. 

It has been supported as a strong palliative or cure in inconti- 
nence of urine depending upon atony of the bladder. 

It is evident that the drug needs to be much more thoroughly 
investigated, there being widely diverse opinions regarding its thera- 
peutic value. There is, however, sufficient testimony in its favor 
from competent authorities to justify further examination and use 
of this extremely active remedy. 

Contraindications. — The meager knowledge we possess re- 
specting its true action in disease renders it impossible to mention 
any special contraindication to its employment. 

Administration. — The tincture is the only preparation used, 
and should be cautiously administered. 

Coca— Cocae— Coca. JJ.S.I*. 

Origin. — The leaves of Erythroxylon Coca Lam., a shrub about 
6 feet (1.8 M.) high, with numerous spreading purplish-brown 
branches, bearing bright green leaves varying in size according to 
the nature of the plant or of the soil in which it grows. The 
flowers, found either alone or in clusters, are small, regular, her- 
maphrodite, white or greenish-yellow, being succeeded by small 
scarlet berries. 

Coca is indigenous in the mountains of Peru and Boliva, and 
on the eastern slopes of the Andes is cultivated in damp, warm 
valleys from 3000 to 6000 feet (9 14.5- 1829 M.) above the sea- 



MOTOR EXCITANTS. 491 

level, being also grown in some parts of Colombia, Brazil, the 
Argentine Republic, and the island of Java. The province of 
La Paz in Bolivia produces the largest crops, the article being 
more highly esteemed than the Peruvian variety. Cocaine, how- 
ever, is obtained from leaves of the Javanese plant. 

Description and Properties. — In size and shape the leaves 
resemble those of tea, ovate, lanceolate, or obovate-oblong, from 
J to 2 or 2f inches (2-5 or 7 Cm.) long and i to \\ inches (25- 
37 Mm.) broad ; short-petiolate] entire, rather obtuse or emarginate 
at the apex, slightly reticulate on both sides, with a prominent 
midrib, and on each side of it a curved line running from base to 
apex ; odor slight and tea-like, taste somewhat aromatic and bitter, 
when chewed temporarily benumbing the lips and tongue. 

The active constituent is the alkaloid cocaine. The plant also 
contains two other alkaloids — ccgoninc and hygrine, and a peculiar 
tannin, coca-tannic-acid, having a green reaction upon salts of iron. 

Dose. — J-4 drachms (2.0-16.0 Gm.). 

Official Preparation. 

Extractum Cocae Fluidum — Extract! Cocae Fluidi — Fluid Extract of Coca. 

— Dose., 20 minins-i fluidrachm (1.2-4.0 Cc). 

Cocaina — Cocainae — Cocaine (unofficial). — Description and Properties. — Color- 
less, p)rismatic crystals, of a strongly alkaline reaction. The taste is bitterish and pro- 
duces a transient numbness of the tongue. Soluble in 704 parts of water, in much less 
alcohol and ether, and in fixed oil. 

Dose. — \-\ grain (0.03-0.06 Gm.). 

Cocainae Hydrochloras— Cocainae Hydrochloratis— 
Cocaine Hydrochlorate. TJ.S.JP, 

This is the only official salt of cocaine, and the one almost 
invariably used in medicine. 

Description and Properties. — Colorless, transparent crystals 
or a white, crystalline powder, odorless, of a sahne, sHghtly bitter 
taste, and producing upon the tongue a tinghng sensation followed 
by numbness of some minutes' duration. Permanent in air, soluble 
in 0.48 part of w^ater and 3.5 parts of alcohol ; very soluble in 
boiling water and in boiling alcohol. 

Dose. — 1—2 grains (0.008-0. 12 Gm.). 

Cocainae Phenas — Cocainae Phenatis — Cocaine Phenate (unofficial). — This 
salt contains about 75 per cent, of the alkaloid. 

Description and Properties. — It occurs as a yellow, viscid mass. Soluble in alcohol, 
insoluble in water. 

Dose. — Y^2~6 gJ'^i'^ (0.005-0.01 Gm.). 



492 A TEXT-BOOK OF MATERIA MEDIC A. 

Antagonists and Incompatibles. — Morphine, chloral, amyl- 
nitrite, alcohol, chloroform, and ether are physiological antagonists. 
The most direct opponents are chloral and morphine. 

Cocaine is incompatible with caustic alkalies and the alkaline 
carbonates and bicarbonates, as well as with bichloride of mercury, 
iodine and the iodides, ammonia, zinc chloride, and borax. 

Synergists. — Medicinally, its cerebral effects may be enhanced 
by the cerebral stimulants, such as alcohol, cannabis Indica, and 
belladonna, while its analgesic and anesthetic action may be aided 
by carbolic acid, atropine, opium, and conium. When used as 
a mydriatic atropine serves as a valuable synergist. 

Physiological Action. — For our first knowledge of the physio- 
logical properties of coca we are indebted to its empirical use 
among the natives of Peru. The history of the drug is replete 
with interest and romance. It was regarded as the living repre- 
sentation of the Deity, the ground whereon it grew being held 
sacred. During the reign of the Incas its use was a royal privi- 
lege, the people being compelled to obtain permission from the 
governor to avail themselves of its benefits. Later it was adopted 
indiscriminately. 

The native coqiieros (coca-chewers) have learned from experi- 
ence that they can climb the Andes, work laboriously in the mines, 
and endure fatigue and hunger more hardily when chewing the 
leaves of the plant, and from time immemorial the drug has been 
recognized by observers as possessing powerful nutritive, stimulant, 
and restorative properties.. 

In describing the action of the crude drug the author can add 
little to the words of Linnaeus, who long ago wrote that coca 
possessed ** the penetrating aroma of vegetable stimulants, the 
astricting and fortifying virtues of an astringent, the antispasmodic 
qualities of bitters, and the mucilaginous, nutritive properties of 
analeptics or of alimentary plants." " This leaf," he adds, " ex- 
hibits with energy its action on all parts of the animal economy. 
Olido in new OS, sapido in fibras, utroqnc in fltddor 

Since the isolation of the alkaloid cocaine, to which the drug 
owes its physiological and medical properties, by Gaedeke in 1855, 
and the subsequent study of it by eminent pharmacologists and 
therapeutists, we have learned more of the physiological action of 
coca. Its effect upon different systems are here described in 
detail. 

Externally and Locally. — Cocaine is analgesic, anesthetic, and 



MOTOR EXCITANTS. 493 

ischemic. Upon the unbroken skin it has no action, but upon 
mucous membranes or the subcutaneous tissue it produces com- 
plete local anesthesia. The surface to Avhich it is applied becomes 
paler than normal, owing to contraction of the blood-vessels, but 
afterward reddens and appears turgescent through secondary dila- 
tation of the vessels. The absorption of the drug by mucous 
membranes varies with- the locality to which it is applied — with 
difficulty from the conjunctiva, yet with great readiness from the 
Schneiderian membrane, producing its characteristic constitutional 
effects. 

Applied to the conjunctiva, or even taken internally, cocaine 
causes a transitory contraction of the pupil, soon followed by dila- 
tation. The accommodation is impaired, but not completely de- 
stroyed, the ocular tension being lowered. 

The anesthetic action of cocaine applied locally is due to the 
depression of the ends of the sensory nerves. It dilates the pupil 
by stimulating the ends of the sympathetic nerve, which innervates 
the radiating fibers of the iris. 

In addition to its local analgesic action the drug possesses the 
power of destroying the functions of the nerves of special sense, 
so that taste and smell, as well as the tactile sense, are abolished. 
When appHed locally or taken internally it primarily checks many 
of the secretions, though those from the pancreas and liver seem 
to be uninfluenced by its internal use. The secondary impression 
of cocaine, however, when the blood-vessels become dilated, is 
accompanied by increased secretion. 

Frangois-Franck, who has made an exhaustive study of the 
local action of cocaine, contends that it is " a powerful paralyzing 
poison, acting alike on sensory and motor nerve-endings, on all 
kinds of peripheral nerves, on nerve-centers, muscles, glands, 
epithelium, leucocytes, vegetable protoplasm, micro-organisms, 
etc." 

Internally. — Digestive System. — On account of its stimulant 
action upon the constrictor fibers of the great sympathetic nerve, 
under the influence of moderate doses peristalsis is largely increased 
in the stomach and intestines, very large or poisonous doses, on 
the contrary, causing great sluggishness of the bowels. 

Although it has been shown by experiments upon animals that 
cocaine is incapable of sustaining life, it diminishes in man the sen- 
sation of hunger, owing to its local anesthetic action upon the 
mucous membrane of the stomach, so that the coqueros are able to 



494 ^ TEXT-BOOK OF MATERIA MEDIC A. 

abstain from food for days, thirst also being allayed. This diminu- 
tion of hunger does not seem to impair appetite and digestion, 
since food is subsequently relished and digested as well as, if not 
better than, if coca had not been used. 

Circulatory System. — Medicinal doses of cocaine increase the 
force and frequency of the cardiac contractions, and also arterial 
pressure. Large or poisonous doses render the pulse slow, soft, 
and weak, and lower arterial tension. The exact modus operandi is 
not fully determined, such eminent authorities as Mosso, Von 
Aurep, Vulpian, Ott, Nikolsky, and others differing as to its action 
upon the circulatory apparatus. It is quite probable that its action 
is similar to that of atropine in this respect. 

Nei'vous System. — When given internally its first action is upon 
the brain, moderate doses greatly stimulating the intellectual facul- 
ties and producing a feeling of ecstasy and well-being, in many 
respects akin to the sensations experienced under the action of 
cannabis Indica. In the course of a few hours the stage of cere- 
bral excitement is succeeded by mental, moral, and muscular 
depression. 

Toxic doses result in incoherent speech and wild delirium, 
accompanied by swaying of the head, followed by epileptiform con- 
vulsions and narcosis. The convulsions are of cerebral origin, the 
effect of cocaine upon the spinal cord being yet but imperfectly 
understood. 

The sensory nerves are depressed by small and paralyzed by 
lethal doses. The motor nerves are also depressed by large doses, 
this action, however, being subordinate to that exerted upon the 
sensory nerves. The muscles are stimulated by medicinal doses 
through impression upon the motor tracts, although large doses 
greatly depress muscular activity. The chewing of coca, as prac- 
tised by the natives of Peru and Bolivia, undoubtedly appears to 
augment muscular strength and powers of endurance. 

Mosso claims that small doses of cocaine serve as a power- 
ful muscular stimulant in cases of exhaustion from hunger or 
fatigue. 

Laffont states that cocaine possesses an " excito-functional action 
on the great sympathetic constrictor nerve, consequently an exalta- 
tion of the functional action of all the non-striated muscles or 
muscles of organic life which are subordinated to it." 

Respiratory System. — Medicinal doses powerfully stimulate the 
respiratory center, increasing the rapidity and depth of the respira- 



MOTOR EXCITANTS. 495 

tions. Poisonous doses paralyze the center, the result being dys- 
pnea, feeble breathing, and death from respiratory failure. 

Absorption and Elimination. — Cocaine is quickly absorbed, being 
eliminated principally by the kidneys in a form differing from its 
original nature. Much of it undergoes oxidation in the body. 
The amount of urine is mcreased, though the nitrogenous ele- 
ments are diminished. The habitual use of the drug lessens urinary 
secretion. 

Cocaine possesses no cumulative action, although its effects 
become more marked under repeated dosage, due probably to 
some special dynamic action upon the nervous system. 

Teniperatiire. — Medicinal doses have no influence on bodily 
heat, but poisonous doses usually raise the temperature, owing, 
according to Reichert, to an increase of heat-production. 

Eye. — Cocaine produces a noticeable dilatation of the pupil, as 
already explained under " Local Action," the maximum change 
being reached in about an hour, and the normal state regained in 
from twelve to twenty-four hours. 

Cocaine-poisoning. — Among the more prominent physiological 
symptoms resulting from the ingestion of excessive doses of coca- 
ine or repeated and continued injections are a tendency to coma 
or collapse ; a feeble, thready pulse, often running extremely high ; 
great emaciation ; anorexia and impairment of the digestive powers; 
and increased frequency, and again alarming depression, of respira- 
tion. There are other symptoms, scarcely less serious, which, as 
the majority of observations show, render cocaine one of the most 
generally deleterious of drugs, opium not excepted.. Dropsy, ma- 
rasmus, numbness, syncope, profound malaise, muscular twitchings 
ivith mild convulsions, insomnia, amblyopia, mydriasis, visual hal- 
lucinations, headache, vertigo, dangerously elevated temperature, 
dental decay, and fetid breath, — even this admonitory catalogue of 
ills fails to complete the recorded phenomena attending poisoning 
from cocaine. 

Yet, grave as are the foregoing physical changes incident to an 
immoderate use of the drug, the mental and, above all, the moral 
effects of cocaine-poisoning are far more deplorable. It is a melan- 
choly but indubitable fact that to one fully committed to the so-called 
" cocaine habit " there appears at times no principle of honor or deco- 
rum to which the vitiated sensibilities are amenable. The enfeeble- 
ment of the intellectual faculties, the loss of memory, inability to 
coordinate or control ideas, a consciousness occasionally merged 



496 A TEXT-BOOK OF MATERIA MEDICA. 

in pronounced mania, possibly with homicidal inclination, and an 
intense selfishness of thought and purpose, in which apathy, neg- 
lect of domestic obligations, and complete debasement of nobler 
qualities are developed, — these lamentable accompaniments mani- 
fest too clearly the degenerating influences exerted by a constant 
resort to the use of this ill-fated, if not fatal, drug. 

An instance coming under the author's personal observation 
will serve to illustrate the entire lapse of the subject's morale. 
The case is that of a well-known, successful, and highly esteemed 
practitioner, who, becoming addicted to the employment of cocaine 
as an alleviation for bodily and mental depression, reached at last 
a stage of moral degradation in which he neither shrank from 
lying and stealing nor considered any means of gratifying his dis- 
eased appetite too abject — the persuasions of friends, the considera- 
tions of professional duty and social position, and the distracted 
appeals of his own family being alike unavailing to arrest the passion 
to which he had succumbed. It is grateful to record that from his 
moral turpitude the subject at length emerged triumphantly, to-day 
occupying a proud position reflecting honor upon himself and his 
profession. 

A still more distressing case, in that it was attended with fatal 
results, is that of a physician personally known to the author 
who, contracting the cocaine habit, in blind folly administered 
the drug to his wife and child, all dying within the period of a 
few months. 

The desperation to which the cocaine habitue may be driven in 
his temporary madness is shown in the case of a young man scarcely 
twenty years of age, son of an eminent surgeon, who, the author 
is authentically informed, during a journey by rail in which he was 
deprived of the customary facilities for hypodermic injection, ripped 
open his arm with a pocket-knife and poured the drug into the 
wound. 

In such cases the salient features of the malady may be prop- 
erly regarded as allied to those of acute mania, the treatment being 
exceedingly difficult — the more so because of the absence of deter- 
rent motives prompted by conscience, which in the course of the 
indulgence becomes torpid or perverted. There is, moreover, with 
cocaine-poisoning always danger of deliberate or involuntary relapse. 

It frequently happens that cocainism arises from a desire to 
relieve effects produced by the immoderate use of opium. Yet the 
latter drug, being taken to offset the influence of cocaine, in reality 



MOTOR EXCITANTS. 497 

but aggravates the evil, the two agents interacting and still further 
lessening the chances of recovery. 

Treatment of Poisoning. — Several antidotes have been favorably- 
adopted — amyl nitrite, caffeine, atropine, and inhalations of ammonia. 
Chloroform, ether, subcutaneously injected, and strychnine have 
also proved more or less efficient remedies. 

With regard to the withdrawal of cocaine, equally competent 
authorities appear to differ, the immediate cessation of the drug 
being advocated, and again this course condemned as liable to 
produce collapse. The author is of the opinion that, as in other 
respects, the procedure followed in the treatment of the opium 
habit is the wisest and safest. 

The disease, however, at least during its more serious manifes- 
tations, is essentially allied to insanity, and permanent cure must 
look to the rationale of the conditions, with the paramount object 
of restoring to its normal activity the moral tone of the patient's 
thought and desire. That complete regeneration of mind and body 
may be reasonably contemplated is amply attested by the case 
above cited ; nor should discouragement deter the physician from 
his task, nor measures of untimely severity be suffered to exas- 
perate and confirm an untoward mental state possibly susceptible 
of intelligent control. 

Therapeutics. — Externally and Locally. — The indications for 
the local anesthetic action of cocaine are very numerous. The 
general surgeon will find many opportunities to employ the drug 
advantageously ; indeed, in many instances it has replaced all 
other anesthetics. In many operations on the genito-urinary tract, 
rectum, nose, throat, ear, and eye it serves a most valuable pur- 
pose. The urethra can be rendered perfectly insensible to pain by 
the application of a 2 to 4 per cent, solution, repeated two or three 
times at intervals of five or ten minutes. Even the sensibility of 
the bladder itself can be benumbed to a great extent by the local 
application of a cocaine solution, so that sounding for stone may be 
painlessly accomplished. A case of litJiotrity is reported in which, 
without suffering, an operation was performed in fifteen minutes, 
the only anesthetic used being a solution of cocaine applied to the 
parts. 

Urethral caruncles may be removed successfully and without 
inconvenience to the patient by the injection of a 4 per cent, solu- 
tion at the Hnes of attachment. An injection of a small amount 
of the same solution into the cellular tissue of the prepuce pre- 

82 



498 A TEXT-BOOK OF MATERIA MEDICA. 

vents pain in circumcision and in the operation for phimosis. In 
the treatment of fisttda in ano, hemorrhoids, both internal and 
external, and other diseases of the rectujn, cocaine is of signal value. 

An OINTMENT OF COCAINE, 4 per cent, strength, affords a grateful 
anodyne dressing for burns, it being borne in mind that in all cases 
where ointments of this drug are used the alkaloid cocaine, and 
not its salts, is to be employed. 

Cocaine is an important anesthetic in many minor operations, 
such as opening oi felons, abscesses, etc.; it is also highly service- 
able in dentistry and for the removal of small neoplasms. Prob- 
ably its most extensive use in this respect is in operations upon 
the eye, nose, and throat, its widest field of usefulness being in 
operative ophthalmic surgery. 

The following prescription makes an efficient application for 
the relief of many of the distressing symptoms of acute coryza 
and hay fever : 

R . Cocainse hydrochloratis, gr. x (0.6 Gm.) ; 

Menthol, gr. xij (0.72 Gm.) ; 

Pulveris camphorse, gr. iij (0.2 Gm.) ; 

Pulveris magnesiae, 

Sacchari lactis, aa. sij (8.0 Gm.). 

M. — Sig. Use a small portion as a snuff twice a day. 

A small quantity of morphine sulphate is sometimes an excellent 
addition to the above. 

The peculiar qualities of cocaine render it one of the safest, as 
well as most convenient and serviceable, mydriatics. It quickly 
dilates the pupil, which regains its normal condition in from ten to 
twenty hours. The dilatation, too, is easily overcome by the 
application of eserine, a solution of \ grain (0.03 Gm.) to i ounce 
(30.0 Cc.) of the latter drug being strong enough to neutralize the 
effects of a 4 per cent, solution of cocaine. 

It should be remembered that local applications to the conjunc- 
tivae, nares, and fauces may produce in susceptible persons systemic 
effects. 

Cocaine combined with atropine forms a mydriatic which for 
many purposes is superior to either drug separately, the mydriasis 
being of longer duration than that produced by cocaine, while the 
paralysis of the accommodative apparatus is briefer than that 
occasioned by atropine. 

The PHENATE OF COCAINE is less toxic than the hydrochlorate, 



MOTOR EXCITANTS. 499 

owing to its power of coagulating albumin, and thereby being less 
readily absorbed. It is also more agreeable to the taste. While it 
does not produce anesthesia so readily as the hydrochlorate, its 
effect is more permanent, and, in addition, it possesses powerful 
antiseptic properties. By many physicians it is preferred in laryn- 
gological work. 

Internally. — Coca has been successfully used in gastralgia and 
to improve the digestion. Cocaine is frequently an efficient remedy 
in sea-sickness and to allay excessive vomiting. 

Bartholow has highly recommended the drug in chorea, asthma, 
paralysis agitans, and alcoholic and sefiile tremor. It has also been 
suggested as a cure for the opium, alcohol, and tobacco habits. 

The WINE OF COCA is an excellent tonic during convalescence 
from acute disease and in debilitated conditions generally. It has 
been extensively employed in melancholia. 

Cocaine combined with atropine is said to make an efficient 
hypnotic. 

Contraindications. — No special or distinct contraindication to 
its use exists. In diseases of the kidneys with diminished urinary 
ilow it should be cautiously administered, lest cumulative effects 
€nsue. With subjects suffering from weak or diseased heart similar 
oaution is to be used. 

Administration. — For hypodermic use solutions of from 2 to 
5 per cent, are generally employed. 

It should be noted that children and females require smaller 
doses of the drug. 

It is altogether probable that many of the coca wines on the 
market contain varying quantities of cocaine. The reckless and 
indiscriminate prescription of these preparations, therefore, is liable 
to induce the cocaine habit. It is questionable, indeed, whether 
the administration of cocaine with a view to curing the intemperate 
use of opium, alcohol, or tobacco is wise. It frequently happens 
that patients thus treated lose their craving for the latter drugs 
only to acquire an inordinate appetite for cocaine, which, as has 
been shown, is possibly more dangerous than either of them in its 
physical and moral effects. 



500 A TEXT-BOOK OF MATERIA MEDICA. 



GROUP VII.— MOTOR DEPRESSANTS. 
Conlum— Conli— Conium. Z7. 8, T. 

(Hemlock.) 

Origin. — The full-grown fruit of Conium inaculatuin L., gath- 
ered while yet green. Spotted hemlock is a biennial indigenous 
in the temperate regions of Asia, Europe, and Northern Africa, and 
naturahzed in some portions of New England, New York, and 
South America. It grows in waste places and along streams. 

Description and Properties. — About \ inch (3 Mm.) long, 
broadly ovate, laterally compressed, grayish-green, often divided 
into two mericarps, each with five crenate ribs, without oil-tubes, 
and containing a seed grooved on the face ; odor and taste slight. 

When triturated with solution of potassium or sodium hydrate 
conium gives off a strong, disagreeable, mouse-like odor. 

The most important constituent is a volatile Hquid alkaloid, 
coniine. It also contains methyl-coniine, conhydrine, and its isomer 
pseudo-conine. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Official Preparations. 

Extractum Conii — Extract! Conli — Extract of Conium. — Dose, \-\ grain 
(0.03-0.06 Gm.). 

Extr^ctum Conli Fluidum — ExtrScti Conii Fluidi— Fluid Extract of Co- 
nium. — Dose, 1-5 minims (0.06-0.3 Cc). 

Unofficial Preparations. 

Tinctiira Conii — Tinctiirse Conii— Tincture of Conium (15 per cent.). — Dose^ 
10-30 minims (0.6-1.8 Cc). 

Siiccus Conii — Siiccus Conii — Conium Juice. — Dose, i-2 fluidrachms (1.8-7.4 
Co.). The juice expressed from fresh leaves, and \ volume of alcohol added to pre- 
serve it. 

Conima — Coniinae— Coniine. — Description and Properties. — A colorless, inflam- 
mable, oily liquid, having a strong alkaline reaction and a penetrating, suffocating odor. 
It is soluble in all proportions in alcohol, ether, chloroform, benzene, benzin, and fixed 
oils. It requires 100 parts of cold water for solution, the liquid becoming turbid on 
warming. 

Dose. — x^Q-i minim (0.006-0.06 Cc). 

Coniinae Hydrobromas — Coniinae Hydrobromatis — Coniine Hydrobro- 
mate. — Description and Pi-operties. — It occurs in colorless, transparent prisms; soluble 
in water and alcohol in the proportion of i to 2 parts ; very slightly soluble in ether. 

Dose. — jQ-i grain (0.002-0.06 Gm.). 



Antagonists and Incompatibles. — Nux vomica and its alka- 



MOTOR DEPRESSANTS. 501 

loids, cocculus and picrotoxin, are antagonistic to conium. Tannic 
acid and the alkalies are chemically incompatible. 

Synergists. — The motor depressants and morphine. 

Physiological Action. — Externally and Locally. — Coniine, the 
active principle of conium, has no effect upon the unbroken skin. 
Applied to bruised surfaces, it has been thought to possess anes- 
thetic or analgesic properties. 

The specific behavior of the drug, however, renders the above 
action problematical, according to some authorities. 

Internally. — Digestive System. — Conium increases the salivary 
secretion, and when taken into the stomach exerts no special action 
upon the digestive system, other than an occasional disturbance of 
the gastro-intestinal tract, possibly resulting in vomiting and diar- 
rhea under full dosage. 

Circnlatory System. — Although when ingested coniine is rapidly 
absorbed by the blood ; circulating in the system unchanged, its 
action is not clearly defined, though it has been held that the cir- 
culation is first accelerated and then retarded, with a lowering of 
arterial pressure preceded by a decided increase. 

From its capacity to paralyze the terminal vagi it is natural to 
suppose that it increases the rapidity of the cardiac movements, 
yet a characteristic feature of the absorption of coniine is the appar- 
ent absence of cardiac derangement, the heart, as well as the mind, 
remaining unaffected in the presence of alarming symptoms. 

Nervous System. — The brain is unaffected, consciousness being 
preserved to the last; muscular irritability is uninfluenced; and 
even under large doses there is little impression made upon the 
nerves beyond a slight impairment of their conductivity due tc 
paralysis of certain ganglia located along the motor nerves, thus 
checking the transmission of motor impulses. This latter influence 
is first manifested in the peripheries, gradually ascending until the 
spinal cord is involved, the reverse process marking the effects of 
methyl-coniine. 

Respiratory System. — Large or poisonous doses act as depres- 
sants upon the respiratory center in the medulla, and, although the 
breathing may at first be normal, paralysis and asphyxia may finally 
result from immoderate ingestion. 

Absorption and Elimination. — The drug is readily absorbed, 
elimination taking place by various channels, but chiefly through 
the kidneys and by expiration. Coniine has been detected in con- 
siderable quantities in the liver, lungs, and spleen. 



502 A TEXT-BOOK OF MATERIA MEDIC A. 

Temperature. — It has been held that bodily temperature is per- 
ceptibly lowered by conium, proportionately with the extent of the 
paralysis occasioned. High authorities, however, assert an increase 
of temperature under both therapeutic and toxic doses. 

Eye. — Heaviness of the eyelids, dilated pupils, accompanied by 
double or confused vision and occasionally entire loss of sight, 
have been noted among the symptoms incident to the administra- 
tion of active dosage. The effects thus recorded have been ascribed 
to paralysis of the third nerve rather than to stimulation of the 
sympathetic. 

Poisoning. — A frequent symptom of conium-poisoning is ptosis, 
arising from paralysis of the oculo-motor nerves. Staggering gait, 
general muscular relaxation, impairment of vision, nausea, and ver- 
tigo are also not infrequent. The severer symptoms are marked 
by muscular paralysis of the extremities, derangement of vocal 
,„ organs resulting in difficulty of speech, and dilatation of the pupils. 

I The brain meanwhile remains unaffected until overcome by the 

accumulation of carbonic-acid gas in the blood, when dehrium and 
coma may ensue, and finally cerebral convulsions and fatal collapse 
through respiratory failure. 

With regard to the effect of toxic doses upon the heart conflict- 
ing statements are recorded, experiment having proved that in 
warm-blooded animals the cardiac movements speedily cease, it 
being authoritatively stated, on the other hand, that the drug exerts 
no influence upon the heart. 

Treatment of Poisoning. — The stomach should be evacuated by 
means of emetics or lavage, after which tannic acid and the phys- 
iological antidotes may be administered — tetanizing agents, such 
as strychnine and picrotoxin, with alcoholic stimuH if necessary. 
Coffee and also hypodermic injections of atropine have been 
highly recommended. Muscular exercise has been known to delay 
the action of the poison, and free counter-irritation by mustard 
may be serviceable. 

Therapeutics. — Externally and Locally. — In many respects 
the medicinal operation of conium bears no relation to its physio- 
logical action. Experimentation shows that it exerts but a feeble 
action upon the sensory nerves, yet clinical experience establishes 
its value in mitigating the pain of cancer when locally applied. In 
ulcerating cancer of the breast especially, poultices composed of 
conium leaves afford wonderful relief from pain and greatly 
improve the condition. A similar application has proved beneficial 



MOTOR DEPRESSANTS. 503 

in scrofulous glandular sores. Dewees has recommended an injec- 
tion composed of the extract 3 parts to water 16 parts in uteriiie 
cancer. 

Ovarian menorrhagia is well treated by inserting in the vagina 
once or twice daily a suppository containing i or 2 grains (0.06- 
0.12 Gm.) of CONIUM. 

Acute laryngitis may be greatly relieved by the inhalation of a 
solution containing 2 fluidrachms (7.4 Cc.) of succus conii to 16 or 
20 ounces (473-591.5 Cc.) of water and 20 grains (1.2 Gm.) of 
sodium carbonate. 

The vapor of coniine inhaled is an efficient palliative of the 
cough of phthisis and acute bronchitis. 

The peculiar mouse-like odor renders the use of conium in dis- 
eases of the respiratory tract objectionable to many persons. 

Internally. — Its action upon the motor mechanism gives value 
to the drug in diseases characterized by excessive motor activity. 
Conium is therefore an efficient remedy in allaying the motor 
excitement of acute mania. Advantage has been taken of its 
action in the treatment of asthma, and in chorea and paralysis 
agitans it certainly serves a useful purpose. 

It has been claimed that whooping cough yields to its influence. 
It has proved beneficial in other spasmodic affections, such as 
tetanus and blephai'ospasm accompanying many acute inflamma- 
tions of the eye. Coniine has even been suggested as a remedy in 
hydrophobia and strychnine-poisoning. 

Coniine hydrobromate has been proposed by Wolfenden as an 
efficient remedy in epilepsy. 

Conium has also been suggested in puerperal convidsions, while 
in infantile convidsions the drug has been employed with great 
benefit, being well tolerated by children. 

Coniine has been used hypodermically and with marked success 
to relax the muscles in dislocations of the joints, as well as in pneu- 
monia and pleurisy. In the latter diseases the drug so depresses 
,the ends of the motor nerves that the impulse exciting the respira- 
tory muscles is interfered with and the cough greatly relieved, a 
reduction of the pulse-rate and temperature usually accompanying 
the cessation of coughing. 

Contraindications. — Conium should not be given to persons 
suffering from great exhaustion and debility or from diseases inter- 
fering with the rhythm of the heart. 

Administration. — The preparations of conium are very unreli- 



504 A TEXT-BOOK OF MATERIA MEDICA. 

able, the fluid extract being perhaps the one to be depended upon 
most uniformly. Owing to the uncertainty of their strength, the 
administration should begin with small doses gradually augmented 
until interference with involuntary motion is observed, when further 
increase should be stopped. 

The effects of the drug are weakened by repeated doses, 
rendering an increase in the dose necessary from time to time. 
Coniine and morphine greatly aid each other, and this combination 
is a particularly efficient one in the treatment of painful muscular 
spasms and acute mania with excessive motor activity. 

Dr. Squibbs has stated that there is danger in diluting the fluid 
extract, a precipitate being formed containing the active principle. 

Gelsemium— Gelsemii— Gelsemium. Z7. S, jP. 

(Yellow Jasmine.) 

Origin. — The rhizome and roots of Gelsemium sempervirens (L.) 
Pers., a plant indigenous in the southern United States, growing in 
moist woods. 

Description and Properties. — Cylindrical, long or cut in sec- 
tions about I inch (25 Mm.) in length, externally hght yellowish- 
brown, with purplish-brown longitudinal lines ; tough, fracture 
splintery ; bark thin, with silky bast-fibers closely adhering to the 
pale-yellowish, porous wood, which has five medullary rays, and 
in the rhizome a thin pith ; odor aromatic, heavy ; taste bitter. 

It contains an alkaloid, gelsemine, which forms its active princi- 
ple, gelseminine, gelseminic acid, volatile oil, resins, gallic acid, etc. 

Dose. — 2-10 grains (0.13-0.6 Gm.). 

Official Preparations. 

Extractum Gelsemii Fluidum — Extracti Gelsemii Fluidi — Fluid Extract 
of Gelsemium. — Dose, 2-10 minims (0.12-0.6 Cc). 

Gelsemlna (unofficial) — Gelseminse — Gelsemine. — Description and Proper- 
ties. — A brittle solid, transparent, crystallizable mass, converted into a colorless liquid at 
45° C. (113° F.). Insoluble in cold water, but soluble to a slight extent in hot water, 
as well as in alcohol ; taste bitter. 

Dose. — 2^0" Co grain (0.0003-0.001 Gm,). 

Antagonists and Incompatibles. — The cardiac and diffusible 
stimulants are antagonistic ; tannic acid and caustic alkalies are 
incompatible, precipitating the alkaloid. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — It is a mild 
sedative and astringent, the alkaloid being a mydriatic. 



MOTOR DEPRESSANTS. 



505 



Internally. — Digestive System. — No special action has been 
noted, though when excessive doses have been taken nausea and 
vomiting may ensue. 

Circulatory System. — Medicinal doses of gelsemium produce no 
marked effect, but toxic doses reduce the heart's action, rendering 
the pulse slower and weaker and lowering arterial tension. 

Nervous System. — The drug has no effect upon higher cerebral 
centers, the mind remaining clear to the last. In large doses it 
paralyzes the roots of the motor cerebral nerves and the motor 
areas of the spinal cord, with consequent paralysis of all the mus- 
cles of the body. This condition is succeeded by cutaneous anes- 
thesia, due to depression of the receiving center and the sensory 
tract in the spinal cord. The motor nerves and muscles are unaf- 
fected. Convulsions rarely result in man from a poisonous dose, 
but occur in animals, with backward movements. The exact cause 
of this action is undetermined. 

Respiratory System. — The breathing is rendered slower and 
shallower, being frequently irregular. Death results from asphyxia, 
■caused by depression and ultimate paralysis of the respiratory center. 

Absorption and Elimination. — Gelsemium is speedily absorbed 
and readily excreted, chiefly by means of the kidneys. Untoward 
symptoms produced by immoderate amounts of the drug prac- 
tically subside within three hours after ingestion. 





Fig. 8.— Diagram showing how gelsemium produces convergent strabismus : A, A, superior rectus ; 
B,B, external rectus — too weak; C,C, internal rectus; D,D, third nerve; E,E, sixth nerve; F,F, 
optic nerve; G,G, lesser wing. 



Temperature. — Poisonous doses cause a reduction in temper- 
ature. 

Eye. — Under full dosage the pupil is widely dilated and diplopia 
and marked ptosis ensue. The mydriasis and ptosis are caused by 



506 A TEXT- BO OK OF MATERIA MEDIC A. 

paralysis of the third nerve. The sixth, which innervates the ex- 
ternal rectus muscle, is often depressed more than the third nerve,, 
supplying the internal rectus, producing convergent strabismus, as 
shown in Figure 8. 

The diplopia is caused by the squint and incoordination of the 
ocular movements. In strabismus the eyes are not directed exactly 
to the object, and the image does not fall on corresponding parts 
of the retinae ; consequently, two perceptions are received in the 
visual center and two objects apparently seen. 

Uterus. — No important action has been observed. 

Untoward Action. — This does not essentially differ from that 
observed in poisoning, though the symptoms may be of a milder 
form. 

Poisoning. — In toxic doses gelsemium is quickly fatal. The 
early symptoms include drooping of the eyelids, wide dilatation 
and immobility of the pupils, extreme muscular weakness, affecting 
first the muscles of the upper extremities, and incoordination of 
movements. Diplopia and dimness of vision may ensue, accom- 
panied by difficulty of speech, coldness of the body surface, and 
general cutaneous anesthesia, with decidedly lower temperature. 
Meanwhile, there is marked diminution in the force and frequency 
of the pulse and respiration. 

While the patient may be drowsy, the mind is unaffected until 
carbonic-acid narcosis supervenes. Death is usually the result of 
respiratory failure, due to paralysis of the muscles of respiration. 
(See Plate L) 

Treatmejit of Poisoning. — The evacuation of the stomach is of 
the first importance, either by the stomach-pump or by the use of 
emetics. Washing out with a solution of tannic acid is probably 
the best method to pursue. External heat should be applied and 
diffusible stimulants administered, followed by digitalis and strych- 
nine. The hypodermic injection of morphine and atropine is 
highly recommended in gelsemium-poisoning. 

Therapeutics. — Externally aiid Locally. — The drug is seldom 
used externally, although it has been employed by ophthalmolo- 
gists as a mydriatic. 

Internally. — Clinically, gelsemium is now considered less valu- 
able than formerly. It has been favorably mentioned by certain 
authors in the treatment of tetanus, mania with motor excitement, 
and paralysis agitans. Theoretically, it would seem to be of value 
in certain convulsive disorders, like chorea, pertussis, etc., yet its 



PLATE II, 





Gelseniium-poisoning, 



I 



MOTOR DEPRESSANTS. 507 

use has not met with the success which its action upon the mus- 
cular system would indicate. 

The drug appears to be more serviceable in trifacial neuralgia, 
and it seems to be even more efficient in neuralgia with involve- 
ment of the inferior dental nerve. In these disorders, as in ovarian 
neuralgia, dysmenorrhea, etc., for which it has been employed with 
some success, the drug should be pushed to its physiological limit. 

Bartholow praised the action of gelsemium in cerebrospinal 
meningitis and " acute inflammations of the lungs and pleura!' 

Bulkley is responsible for its use in pruiitus and eczema, the 
itching of which it certainly appears to alleviate. 

The therapeutics of gelsemium would perhaps be incomplete 
without mentioning hemoptysis, remittent fever, acute coryza, mi- 
graine, Meniere's disease, and spermatorrhea, in all of which the 
drug has been used and recommended. 

Contraindications. — Diseases accompanied by exhaustion and 
great muscular weakness. 

Administration. — Any of the preparations may be given, the 
initial dose being small, and the amount increased gradually until 
dilatation of the pupil or drooping of the eyehds is manifest. 

Grindelia— Grindeliae— Grindelia. 17. >S^. P, 

Orig-in. — The leaves and flowering tops of Grindelia robusta 
Nutt, and of Grindelia squarrosa Dunal, herbaceous or suffruticose 
perennials indigenous in the western part of North America and 
Mexico. 

Description and Properties. — Leaves about 2 inches (5 Cm.) 
long, varying from broadly spatulate or oblong to lanceolate, sessile 
or clasping, obtuse, more or less sharply serrate, often spinous- 
toothed or even laciniate-pinnatifid, pale-green, smooth, finely 
dotted, thickish, brittle ; heads many-flowered, subglobular or 
somewhat conical, the involucre hemispherical, about -| inch 
(10 Mm.) broad, composed of numerous imbricated, squarrose- 
tipped, or spreading scales; ray-florets yellow, liqulate, pistillate; 
disk-florets yellow, tubular, perfect ; pappus consisting of two or 
three awns of the length of the disk-florets ; odor balsamic ; taste 
pungently aromatic and bitter. 

The principal constituent is probably a resinous substance. It 
also contains an alkaloid principle, grindeline, and a volatile and a 
fixed oil. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 



5o8 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

ExtrSctum Grindeliae Fluidum — Extr^cti Grindeliae Fluidi — Fluid Extract 
of Grindelia. — Dose, 10-60 minims (0.6-3.7 Cc). 

Antagonists and Incompatibles. — The motor excitants and 
cerebral stimulants are antagonistic. Aqueous preparations, the 
caustic alkalies, and mineral salts are incompatible. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — The drug is 
sedative and mildly astringent. 

Internally. — Digestive System. — When ingested it excites a sense 
of warmth in the epigastrium, and in moderate doses increases the 
secretion of the gastric juice, stimulating the appetite and improv- 
ing digestion. 

Circulatory System. — It differs somewhat from conium in that 
the heart is slowed by medicinal doses through stimulation of the 
inhibitory center. The blood-pressure, however, is raised and 
maintained by stimulation of the vaso-motor center. 

Nervous System. — Grindelia possesses considerable hypnotic 
power. Its effect upon the motor mechanism is similar to that of 
conium, the muscular weakness affecting first the lower extremi- 
ties. The sensory nerves are first depressed, there being quite 
marked cutaneous anesthesia. The drug depresses the reflex 
mechanism in the spinal cord, so that the reflex movements are 
greatly lessened : it is said that it also depresses the phrenic nerve. 

Respiratory Systejn. — Small doses have little effect upon the 
respiratory movements ; large doses retard the breathing ; while 
toxic doses may produce death through paralysis of the respiratory 
muscles. 

The drug sHghtly increases the secretion from the pulmonary 
mucous membrane, and relaxes the circular fibers of the bronchial 
muscles through depression of the ends of the motor fibers of the 
vagus distributed to these muscles and of the reflex center in the 
medulla. The ends of the sensory nerves distributed to the pul- 
monary mucous membrane are also depressed. 

Absorption and Elimination. — Grindelia is readily absorbed, and 
is eliminated chiefly by the kidneys, increasing the urinary flow, 
the lungs sharing in the excretory process. 

Temperature is unaffected. 

Eye. — Large doses cause dilatation of the pupil. 

Uterus. — No effect has been noticed. 

Untoward Action. — Excepting drowsiness, reduction of cutane- 



MOTOR DEPRESSANTS. 



509 




ous sensibility, slight gastric disturbance, and a feeling of weakness 
no symptoms have been recorded. 

Poisoning. — The drug is feebly toxic ; excessive doses, how- 
ever, act as a gastro-intestinal irritant. The patient is sleepy and 
complains of muscular weakness ; there 
is a numb or anesthetic condition of the 
skin, while the pupils are dilated and 
the pulse and respiratory movements 
slow and feeble. Should death occur, 
it will be from paralysis of the muscles 
of respiration. 

Treatment of Poisoning. — The same 
as in poisoning from conium — diffusible 
stimulants, strychnine, etc. 

Therapeutics. — Externally and Lo- 
cally. — Grindelia is a very efficient ap- 
plication to the skin in rhus-poisojiing. 
Indeed, it serves as a soothing lotion in 
many acute inflammations of the skin, 
such as eczema^ etc. The fluid extract 
used should be well diluted and applied 
on cloths. 

Indolent idcers are well treated by a 
diluted solution of the drug. It also 
serves as an efficient injection in gonor- 
rhea, leucorrhea, and vaginitis. 

Internally. — Grindelia has acquired 
an enviable reputation as a remedy for 

. . , The diaphragm (i^) is relaxed through 

Spasmodic asthma, its action upon the depression of the phrenic nerve (Z?). 

bronchial muscles rendering it singu- 
larly beneficial in this disorder. It acts upon every possible point 
to relax the spasm of the bronchial muscles, as is shown in Fig- 
ure 9. The drug has no influence, however, in preventing a recur- 
rence of the paroxysms. 

The drug has been highly recommended in acute and chronic 
bronchitis, hay fever, whooping cough, and in spasmodic cough of 
whatever nature. It has even been suggested as a palliative remedy 
in pneumonia and cardiac and pulmonary dyspnea. 

There are no special Contraindications or directions for Ad- 
ministration, save that the fluid extract is pharmaceutically incom- 
patible with aqueous preparations. 



Fig. 9. — Diagram showing how grin- 
deHa relaxes spasm of the bronchial 
muscles in asthma. The sensory nerves 
(5) in the mucous membrane of the 
bronchial tubes are depressed, so that 
there is less irritation transmitted to 
the medulla, to be returned by the 
motor fibers supplying the bronchial 
muscles, thus exciting bronchial spasm. 
The respiratory center {A) is depressed, 
together with the ends of the motor 
nerves (C;, limiting the amount of irri- 
tation in the bronchial muscles {E). 



5IO A TEXT-BOOK OF MATERIA MEDICA. 

Physostigrma— Physostigrmatis— Physostigma. 

U. 8, jP. 

(Calabar Bean.) 

Origin. — The seed of Physostigma veneitosum Balfour, a lofty, 
half-shrubby, climbing plant (somewhat resembling the scarlet- 
runner or Spanish bean of our gardens) growing near the mouths 
of the Niger and Old Calabar River in Western Africa, and attain- 
ing a height of 40 or 50 feet (12-15 ^O- 

Description and Properties. — The seeds are about \ 'lo i\ 
inches (25-30 Mm.) long, f to f inch (15-20 Mm.) broad, and f to 
finch (10-15 Mm.) thick; oblong and somewhat reniform ; testa 
granular, chocolate-brown, with a broad black groove extending 
the entire length of the convex edge ; embryo with a short, curved 
radicle and two large, white concavo-convex cotyledons ; inodor- 
ous ; taste bean-Hke. 

The drug contains an alkaloid, physostigmine (also known as 
eserine)^ which is the principal constituent ; calabarine^ to which the 
drug owes its tetanizing properties ; and eseridine (a laxative and 
motor excitant) ; besides a neutral principle, physosterin, related to 
cholesterin. 

Dose. — 1-4 grains (0.065-0.25 Gm.). 

Official Preparations. 

Extractum Physostigmatis — ExtrScti Physostigmatis — Extract of Physo- 
stigma. — Dose, -^-^-\ grain (0.004-0.01 Gm.). 

Tinctura Physostigmatis — Tincturse Physostigmatis — Tincture of Physo- 
stigma. — Dose, 5-10 minims (0.3-0.6 Cc), 

The alkaloid, Physostigmine, is not official. It occurs in colorless or slightly pink- 
ish crystals ; sparingly soluble in water ; readily soluble in alcohol. — Dose, ^o o~2V grain 
(0.0006-0.003 Gm.). The salicylate and sulphate of physostigmine are official, 

Physostigminae Salicylas — Physostigminae Salicylatis — Physostigmine 
Salicylate (Eserine Salicylate). U. S. P. 

Description and Properties. — Colorless or faintly yellowish, shining, acicular, or 
short, columnar crystals, odorless, and of a bitter taste ; acquiring a reddish tint when 
exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The 
salicylate should be kept in small, dark amber-colored, and well-stoppered vials. 

Dose. — ^i^-Jg. grain (0.0005-0.002 Gm.). 

Physostigminae Stilphas — Physostigminae Sulphatis — Physostigmine Sul- 
phate (Eserine Sulphate). U. S. P. 

Description and Properties. — A white, or yellowish-white, micro-crystalline pow- 
der, odorless, and of a bitter taste. It is very deliquescent when exposed to moist air, 
gradually turning reddish in air and light. Very soluble in water and alcohol ; still 
more so at the boiling-point of these Hquids. It should be kept in small, dark amber- 
colored, and well-stoppered vials. 

Dose. — i^o~3V g^^^"^ (0.0005-0.002 Gm.). 



MOTOR DEPRESSANTS. 



Unofficial Preparation. 



511 



PhysostigmTnae Hydrobromas — Physostigminae Hydrobromatis — Physo- 
stigmine Hydrobromate. — Dose, j|o~3V grain (0.0005-0.002 Gm.). 

Antagonists and Incompatibles. — The action of physostigma 
upon the heart, respiration, and pupils is antagonized by atropine ; 
that on the spinal cord by chloral ; while, in a general way, the 
motor excitants, particularly the tetanizing agents, are therapeuti- 
cally antagonistic. 

The caustic alkalies and tannic acid are chemically incompatible. 

Synergists. — The motor depressants. 

Physiological Action. — Externally and Locally. — No external 




Fig. 10. — Diagram illustrating the mechanism of secretion. An impression is transmitted over the 
aflferent nerve {B) to the medulla {A), and thence over the secretory nerve (C) to the secretory cells 
{K, K) of the gland (F). At the same time the vaso-motor nerves {E) are stimulated, causing a con- 
traction of the arterioles (/) supplying the gland ; hence, as soon as the lymph in the lymph-spaces 
{H) is consumed, the secretion from the gland is diminished for lack of material necessary to the 
secretory cells in elaborating their normal secretions. 



action of physostigma and its preparations is noted, unless it be its 
effect upon the pupil, which outward appHcation contracts, and the 
slight abolition of functional activity in the motor and sensory 



512 A TEXT-BOOK OF MATERIA MEDICA. 

nerves, occasioned, it is said, by a strong solution of physostig- 
mine. 

Internally. — Digestive System. — The administration of the drug 
tends to stimulate the salivary, gastric, and intestinal secretions, 
followed by lessened secretion (see Figure lo), and, by acting 
upon the muscular coats of the stomach and intestines, to increase 
peristalsis. Nausea, retching, vomiting, and purging may result. 
The rationale of its action is doubtless direct stimulation of the 
unstriped muscle-fibers. 

Circulatory System. — No influence on the blood has been de- 
tected. Small doses increase arterial tension, the heart's action 
becoming slower and stronger. 

Although the effect upon the heart is somewhat obscure, it 
appears that under poisonous doses the cardiac pulsations are 
greatly reduced, being slow and feeble, and finally ceasing alto- 
gether. It is reasonably supposed that this action is due to pri- 
mary stimulation of the peripheral vagi, influencing the cardiac 
ganglia, and also to the effect upon the vaso-motor centers. The 
subsequent exhaustion and relaxation of the arteries are doubtless 
the result of a similar influence. 

There is marked elevation of blood-pressure under moderate 
doses, although there may occur a brief period of depression. 
Toxic doses are accompanied by a notable decrease of arterial ten- 
sion, the cardiac gangHa being seized with paralysis and the heart 
finally arrested in diastole. 

Nervous System. — As with conium, the mind is comparatively 
unaffected by physostigma, remaining lucid even to the verge of 
final collapse. The spinal cord, however, appears to bear the prin- 
cipal shock, the total abolition of reflex activity indicating a selective 
action of the drug. 

To the effect on the motor nerves, occasioning a diminution of 
power, must be attributed the muscular debility and paralytic 
symptoms manifest under the administration of toxic doses. 

Respiratory System. — No interference with respiration is caused 
by moderate doses of the drug. Larger amounts primarily de- 
press the respiratory centers, stimulate the peripheries of the pul- 
monary vagi, and contract the caliber of the bronchial tubes, even 
to the extent of serious constriction, death usually resulting from 
asphyxia. 

The breathing is first quickened and then retarded, the effect of 
the drug upon the respiration being more powerful than its circu- 



MOTOR DEPRESSANTS. 5^3 

latory influence, the heart continuing to beat for some time after 
pulmonary action has ceased. 

Absorption and Elimination. — The active principles of physo- 
stigma and its alkaloids are rapidly diffused in the blood. They are 
largely excreted by the kidneys, the bile and saliva contributing to 
the process of elimination, and have been detected in the gastric 
juices after intravenous injection. 

Temperature. — A slight depression has been noted. 

Eye. — AppHed locally to the conjunctiva or introduced into the 
circulation, whether by ingestion or injection, physostigmine causes 
myosis or contraction of the pupil by stimulating the peripheral 
endings of the oculo-motor nerves, possibly by a depression of the 
sympathetic fibers. 

Other prominent symptoms present are spasm of accommoda- 
tion and decreased intraocular tension and myopia. Irritation of 
the third nerve is the principal cause of these phenomena : they 
have also been attributed to the stimulating action of the drug 
upon the muscular fibers of the iris rather than to any paralyzing 
influence upon the sympathetic, pupillar dilatation being manifest 
under excitation of the latter nerve. 

The intraocular pressure is lowered (i) by lessening the blood- 
supply to the eye through contraction of the blood-vessels ; (2) by 
diminishing the secretion of the aqueous humor from the glands on 
the surface of the ciliary body ; (3) by contracting the iris, so that 
the aqueous humor can more readily pass through the canal of 
Schlemm. 

Uterus. — The full influence of the drug tends to produce uterine 
contraction. 

Untoward Action. — When eserine is applied to the eye it occa- 
sionally produces a nervous contractile pain in the entire eyeball, 
which extends in a manner similar to ciliary neurosis along the 
course of the supraorbital nerve, resembling migraine. 

Small doses have in some individuals produced nausea and 
general uneasiness, and occasionally intense pain in the epigas- 
trium. 

Poisoning. — Taken in poisonous doses, physostigma causes 
nausea, giddiness, and muscular tremors and weakness, followed 
by complete muscular relaxation. Cardiac action is diminished ; 
the reflexes are in abeyance ; the respiration is retarded ; and 
myosis and motor paralysis are manifest. The pupils visibly con- 
tract, and purging and vomiting may ensue. Fatal results are 
33 



514 A TEXT-BOOK OF MATERIA MEDICA. 

possible through paralysis of the respiratory center and consequent 
asphyxia. The more rapid collapse succeeding the administration 
of lethal doses is due to cardiac syncope. 

Treatment of Poisoning. — The stomach should be evacuated, the 
process being followed by the hypodermic injection of a solution 
of atropine, which may prove an efficient physiological antidote. 
Tannic acid may be used as a chemical antagonist. Diffusible 
stimulants, such as ether or ammonia, may serve to arrest cardiac 
and respiratory failure. Digitalis and alcohol have also been suc- 
cessfully employed. Temperature should be maintained by the 
application of external heat. 

Therapeutics. — ExterJially and Locally. — Physostigmine and 
ESERINE SULPHATE are the preparations usually employed, their only 
action of importance being in diseases of the eye. They are of 
value in breaking up adhesions of the iris to the cornea or lens, 
strengthening the muscle of accommodation, reducing intraocular 
pressure, and removing the effects of atropine, although Jessup 
claims that complete ciliary paralysis by atropine and the mydriasis 
induced by hyoscine are unaffected by eserine. 

In certain cases of ulcer of the cornea uncomplicated with iritis 
and sloughing keratitis, where there is little inflammation or ciliary 
irritation, eserine sometimes produces prompt improvement when 
atropine has failed. 

Paralytic mydriasis and paralysis of accommodation are tempo- 
rarily relieved by this drug, and weak solutions have been employed 
with varying success in accommodative asthenopia without refrac- 
tive errors. 

The remedy is of unquestioned value in the early stages of 
glaucoma, but only at the commencement of an acute attack and 
contraindicated in the hemorrhagic form. Should the drug fail to 
contract the pupil when used for glaucoma, it may induce irritating 
spasm of the ciliary muscles by increasing the blood-supply to the 
iris. 

Physostigmine is sometimes employed to prevent prolapsus of 
the iris, following peripheral perforation of the cornea or cataract 
extraction, particularly without iridectomy. 

The remedy serves a useful purpose also in coal-miners' 7tys- 
tagmus, one drop of a collyrium containing \ grain (0.096 Gm.) of 
physostigmine sulphate in i ounce (30.0 Cc.) of distilled water 
being dropped into the eye three times a day. Eserine is also em- 
ployed in neuralgia of the eyeball 's.ViA photophobia. 



MOTOR DEPRESSANTS. 5^5 

Internally. — Physostigma has proved efficacious in constipation 
due to an atonic condition of the intestines with deficient secretion. 
The state of the muscular intestinal layer frequently allows gas to 
accumulate in the bowels, with consequent troublesome JlattdeJice, 
The drug, by imparting tone to the muscles and increasing peri- 
stalsis, greatly relieves this unpleasant condition. 

Gastric and intestinal dilatation have been successfully treated 
by Hare with this remedy. It is valuable in chronic bronchitis with 
dilatation of the bronchial tubes, and is said to relieve bronchial 
asthma and emphysema. 

Progressive paralysis of the insane is sometimes relieved by 
PHYSOSTIGMA, while its good reputation in tetanus is well estab- 
lished. It has been used, but with less favorable results, in chorea, 
epilepsy, infantile convidsions, and other spasms. Some authorities 
have recommended it in the treatment of paraplegia due to myeli- 
tis, renal hemorrhage , night-sweats of phthisis, and locomotor ataxia. 

Contraindications. — The same as for conium. 

Administration. — The extract or the tincture is usually pre- 
ferred for internal administration, although the alkaloid fully repre- 
sents the drug and may be given either by the mouth or hypo- 
dermically. For appHcation to the eye the salts of the alkaloid 
are used. A convenient form of eserine in ophthalmic practice is 
the medicated gelatin disks. 

Curare— Curare— Curare. 

(WOORARI.) 

Origin. — An extract of uncertain composition prepared by the 
natives of South America as an arrow-poison. Dr. Jobert reported 
to the French x\cademy in 1878 that the poison was prepared 
chiefly from Strychnos Castelnceana and other species of Strychnos, 
and Coccidus toxiferus, containing also variable quantities of other 
poisonous plants, such as Didelphys cancrivora, etc. It is alto- 
gether probable that its ingredients include the poison of venomous 
reptiles. 

Description and Properties. — The extract is a blackish-brown, 
friable soHd, brittle or hygroscopic, of a very bitter taste ; almost 
completely soluble in dilute alcohol. Cold water dissolves about 
75 per cent., which portion contains the poisonous alkaloids and is 
insoluble in ether and but sparingly soluble in absolute alcohol. 

Two alkaloids have been obtained from this substance — curarine 
and ciirine. 



5^6 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — 2V~i gi'^in (0.003-0.03 Gm.), hypodermically given. 

Dose of Curarine. — 2To~tt"o gi*ain (0.0003-0.0006 Gm.), hypo- 
dermically. 

Antagonists and Incompatibles. — The excito-motors are an- 
tagonistic. Tannic acid and the caustic alkaHes are chemically 
incompatible. 

Synergists. — The depresso-motors. 

Physiological Action. — When applied to the denuded skin it is 
a powerful irritant ; introduced into the circulation hypodermically, 
it exerts a very decided and characteristic action. 

Circulatory System. — Medicinal doses render the pulse fuller 
and exceedingly rapid ; there is marked dilatation of the blood- 
vessels of the skin and the various glands ; while the blood-pres- 
sure, though little affected by small doses, is decidedly lowered by 
large ones. The action on the circulation is due to diminished 
inhibition on the heart, owing to paralysis of the ends of the vagi, 
while the accelerator nerves are stimulated. 

Nervous System. — Immoderate doses cause great muscular 
weakness and paralysis of all the voluntary muscles. The ends 
of the motor and sensory nerves are paralyzed, the former being 
soonest affected. Beyond a slightly diminished contractility the 
voluntary muscles are but little influenced. The spinal cord may 
be paralyzed under toxic doses, although the brain-centers remain 
unaffected until carbonic-acid narcosis sets in. 

Respiratory System. — Curare is a powerful respiratory depress- 
ant, paralyzing the ends of the motor nerves distributed to the 
respiratory muscles. When lethal doses have been given the 
paralysis becomes central, finally producing death by its action on 
the respiratory muscles. 

Absorption and Elimination. — When ingested the process of 
absorption is exceedingly slow, but when injected into the circula- 
tion the drug is rapidly absorbed. 

It is quickly eliminated by the kidneys, causing sugar to appear 
in the urine. A portion of the poison is also excreted with the 
feces. The sweat, saliva, nasal mucus, and tears, although their 
secretion is greatly increased by the drug, do not seem to share in 
the process of ehmination. 

Temperature. — The temperature is elevated. 

Eye. — Under poisonous doses there is marked ptosis, disordered 
vision, protrusion of the eyeballs, and, as a late ocular symptom, 
myosis. 



MOTOR DEPRESSANTS. 51? 

Poisonmg. — Curare is a rapid and active poison. The move- 
ments of the heart are greatly accelerated ; the pulse is weak and 
dicrotic ; the temperature is elevated, and the respiration corre- 
spondingly depressed ; extreme muscular weakness ensues, with 
incoordination of movements ; the urine becomes saccharine. 
Finally, paralysis of the extremities and the respiratory muscles 
supervenes, death occurring from respiratory paralysis. 

Treatment of Poisoning. — The same as in the treatment of poi- 
soning from conium, with catheterization of the bladder to favor 
elimination, and artificial respiration. 

Therapeutics. — While of great scientific interest and of value 
for experimental purposes in ascertaining the effect of certain drugs 
upon animals, the therapeutic uses of curare are quite limited, being 
confined to certain spasmodic diseases, particularly hydrophobia. The 
remedy has also been used with varying success in chorea, tetanus, 
and epilepsy, but when the convulsions are due to excessive activity 
of the cerebral motor areas the bromides are superior to curare. 

Contraindications. — The same as for conium. 

Administration. — The crude drug or the alkaloid curare should 
be given hypodermically. 

Aspidosperma— Aspidospermatis— Aspidosperma. 

77. H. 1>. 

Origin. — The bark oi Aspidosperma Quebracho-bianco Schlech- 
tendal, a large evergreen tree, of exceedingly hard wood (Sp. 
qttebrar, to break, and hacha, an axe), indigenous in the Argentine 
Republic. 

Description and Properties. — Occurring in nearly flat pieces 
about \ to \\ inches (12.0-30.0 Mm.) thick ; the outer surface yel- 
lowish-gray or brownish, deeply fissured, inner surface yellowish- 
brown or reddish-brown, distinctly striate ; fracture displaying two 
sharply-defined strata of about equal thickness, both marked with 
numerous whitish dots and striae arranged in tangential lines ; the 
fracture of the outer lighter-colored layer rather coarsely granu- 
lar, and that of the darker-colored inner layer short-splintery; 
inodorous ; taste very bitter and slightly aromatic. 

Six alkaloids have thus far been isolated from aspidosperma, the 
most important being aspidospermine and qnebrachifie , the former 
occurring in colorless prismatic crystals insoluble in water and 
soluble in 48 parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



5lS A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 

Extractum AspidospSrmatis Fluidum — Extr^cti AspidospSrmatis Fluidi — 
Fluid Extract of Aspidosperma. — Dose, 5-30 minims (0.3-1.8 Cc). 
Aspidospermine (unofficial). — Dose, \-^ grain (0.016-0.03 Gm.). 
Quebrachine (unofficial), — Dose, 1-2 grains (0.06-0.12 Gm.). 

Physiological Action. — Externally and Locally. — No important 
action has been noted. 

Jjiternally. — Digestive System. — It is a stomachic, having an 
action analogous to the vegetable bitters. 

Circulatory System. — Aspidosperma depresses the heart, render- 
ing its action slower, with reduction of arterial tension. 

Nervous System. — In its action it resembles conium. It de- 
presses the motor mechanism by its influence on the motor centers, 
and lessens the reflexes through its influence on the spinal cord. 
Excessive doses cause vertigo and headache, together with paraly- 
sis of the extremities, the lower being first affected. 

Respiratory System. — Medicinal amounts of aspidosperma retard 
the breathing, but deepen the inspirations ; aspidospermine, on the 
contrary, increases the respiratory movements. Toxic doses para- 
lyze the respiratory center, death resulting apparently from asphyxia 
and convulsions. 

Absorption and Elimination. — It readily passes into the blood, 
and is excreted chiefly by the urine, the saliva and sweat sharing 
in the process of elimination. 

Temperature. — It is antipyretic, febrile temperature being re- 
duced by full doses of the drug. 

Poisoning. — Aspidospermine is an active respirator}^ poison, the 
toxic symptoms being vertigo, headache, free diaphoresis and sali- 
vation, great muscular weakness, with paralysis of the lower 
extremities, slow and weak heart, reduction of temperature, marked 
depression of the respiration, and death from respiratory failure. 

Treatme7tt of Poisoning. — The same procedure is advisable as in 
cases of poisoning from the other motor depressants. 

Therapeutics. — Aspidosperma is not employed locally, its chief 
value being in the treatment of dyspnea of whatever variety, though 
it is fair to state that Pluzoldt considers it contraindicated in cardiac 
dyspnea. 

The drug is equal, if not superior, to grindelia in the treatment 
of spasmodic disorders of the respiratory apparatus. 

By some cHnicians it is claimed to be an efficient remedy in 
pneumonia, being especially useful in relieving cyanosis. 



MOTOR DEPRESSANTS. 519 

AsPiDOSPERMiNE has been highly recommended as an anti- 
periodic in malaria, and has appeared to modify the symptoms of 
acute articular rJieuinatism. 

Administration. — Both the fluid extract and the alkaloid may 
be given internally, although a favorite and efficient method of 
administering the alkaloids is by hypodermic injection. 

Sumbul— Sumbul— Sumbul. TJ, S, JP. 

Orig-in. — The root of Ferula sumbul (Kauffmann) Hooker fil, a 
perennial about 8 feet (2.4 M.) high, indigenous in regions north 
and east of British India. 

Description and Properties. — It occurs in transverse segments, 
varying in diameter from i to 3 inches (2-7 Cm.), and in length 
from 6 to 12 inches (14-30 Cm.); hght spongy, annulate or longi- 
tudinally wrinkled ; bark thin, brown, more or less bristly fibrous ; 
the interior whitish, with numerous brownish-yellow resin-dots and 
irregular, easily separated fibers ; odor strong, musk-like ; taste 
bitter and balsamic. It contains sumbulic and valerianic acids, a 
small quantity of volatile oil, and two balsamic resins to which its 
odor is due. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Official Preparation. 

Tinctura Stimbul — Tincturse Siimbul — Tincture of Sumbul. — Dose, 15-60 
minims (1.0-3.7 Cc). 

The drug has not yet been carefully studied. It is unknown 
just what substances are incompatible with it, though the motor 
excitants are probably antagonistic. The exact physiological action 
is not definitely understood, yet so far as it has been investigated it 
seems to possess some of the properties of both the motor de- 
pressants and antispasmodics, having a sedative action upon the 
brain and spinal cord. 

Therapeutics. — The drug is valuable in the various manifesta- 
tions of hysteria, and has been employed with some success in 
ovarian neuralgia and dysmenorrhea. 

It is similar to, though not so efficient as, grindelia in spasmodic 
coughs. Indeed, most of the disorders benefited by the antispas- 
modics yield to the influence of sumbul. 

In neurastlienia with anemia the extract of sumbul, combined 
with iron and arsenic, serves a very useful purpose. 



520 A TEXT-BOOK OF MATERIA MEDICA. 

Administration. — It may be given in the form of the tincture, 
or the extract may be administered in pill form. 

Viburnum Prunifolium— Viburni Prunifdlii— Black 

Haw. 77. S. P. 

Origin. — The bark of Viburnum prunifolium L., a tall shrub or 
small tree lo to 20 feet (3-6 M.) high, growing in thickets through- 
out the greater portion of the United States east of the Mississippi. 

Description and Properties. — Thin pieces or quills, glassy 
purplish-brown, with scattered warts and minute black dots ; when 
collected from old wood, grayish-brown, the thin corky layer easily 
removed from the green layer ; inner surface whitish, smooth ; frac- 
ture short ; inodorous ; somewhat astringent and bitter. 

It contains a bitter principle (viburnin), a bitter resin, valerianic 
acid, besides tannic, oxalic, citric, and malic acids. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Official Preparation. 

ExtrSctum Vibtirni Prunifolii Fluidum — Extr^cti Vibtirni Prunifolii Fluidi 
—Fluid Extract of Black Yia^N}—Dose, %-i fluidrachm (1.8-3.7 Co.). 

Antagonists and Incompatibles. — It is chemically incompatible 
with iron and other substances affected by tannic acid. 

Synergists. — Antispasmodics and uterine sedatives. 

Physiological Action and Therapeutics. — The action of black 
haw is not thoroughly understood. It appears to have a sedative 
action upon the spinal centers, similar in many respects to that of 
conium. It acts as an antispasmodic, diuretic, nervine, and tonic, 
being especially useful in various uterine disorders, such as spas- 
modic and m,embranous dysmenorrJiea. 

The various vaso-motor disturbances and the mcnoi^rhagia inci- 
dent to the menopause are frequently relieved by this remedy. It 
is also of some value in the prevention of abortion. Its sedative 
properties render it serviceable in relieving the severity of after- 
pains. 

Liquor Sedans (P., D. & Co.) is superior to the fluid extract of 
black haw for the disorders mentioned. 

Contraindications and Administration require no special com- 
ment or suggestion. 

1 Parke, Davis & Co. of Detroit manufacture a preparation called Liquor Sedans, 
intended as a substitute for certain secret preparations. The formula is given on the 
label of each bottle, and the remedy is composed of black haw, golden seal, and Jamaica 
dogwood, combined with aromatics, in the form of an elixir. 



MOTOR DEPRESSANTS. 52 1 

Viburnum Opulus— Viburni Opuli— Cramp Bark. 

JJ. S. J>. 

Origin. — The bark of Viburmim Optihis L., a small tree 10 to 
15 feet (3-4.5 M.) high, indigenous in Canada, the Northern United 
States, Europe, and Northern Asia. 

Description and Properties. — Flattish or curved bands, or 
occasionally quills, sometimes 12 inches (30 Cm.) long and from 
2V to Jg inch (1-1.5 Mm.) thick; outer surface ash-gray, marked 
with somewhat transversely scattered, elongated warts of a brown- 
ish color, due to abrasion, and marked more or less with blackish 
dots, with black, irregular hues or thin ridges, arranged chiefly in 
a longitudinal direction; underneath the easily-removed corky 
layer of a pale-brownish or reddish-brown color ; the inner surface 
dingy white or brownish ; fracture tough, the tissue separating in 
layers ; inodorous ; taste somewhat astringent and bitter. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 

ExtrSctum Vibtirni Opuli Fluidum— ExtrScti Vibtirni Opuli Fluidi— Fluid 
Extract of Cramp Bark. — Dose, 1-2 fluidrachms (3.7-7.3 Cc). 

The general observations upon Viburnum prunifoHum are appH- 
cable to this drug. 

Acidum Hydrocyanicum Dilutum— Acidi Hydrocy- 
anic! Diluti— Diluted Hydrocyanic Acid. U.S. P. 

(Prussic Acid.) 

Orig-in. — A liquid composed of 2 per cent, by weight of abso- 
lute Hydrocyanic Acid and 98 per cent, of Water, prepared by 
distilling a mixture of Potassium Ferrocyanide, Sulphuric Acid, 
and Water into Distilled Water. 

Description and Properties. — A colorless liquid, of a charac- 
teristic odor and taste, resembling those of bitter almonds. As it 
is very poisonous, great care should be taken i7i tasting it. It should 
be kept in small, dark-amber colored, cork-stoppered bottles, in 
a cool place. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Antagonists and Incompatibles. — Atropine is a physiological 
antagonist, the diffusible stimulants also counteracting the effects 
of the drug. The metallic salts, particularly cobalt nitrate, are 
chemically incompatible. 



522 A TEXT-BOOK OF MATERIA MEDICA. 

Synergists. — The cardiac and motor depressants. 

Physiolog-ical Action. — Externally and Locally. — Applied lo- 
cally to the unbroken skin, its first effect is sHghtly irritating, but 
soon after sedative and anesthetic, because of its influence in 
causing paralysis of the sensory nerve-endings. 

It is very rapidly absorbed from raw surfaces, even toxic effects 
resulting from its application. 

Inter7tally. — Digestive System. — Being quickly absorbed by the 
mucous membranes, hydrocyanic acid acts as an anesthetic and 
sedative upon the stomach, moderate doses having little influ- 
ence upon a healthy organism. Toxic doses may be followed by 
vomiting and the terribly lethal action of the drug, the peculiarly 
sudden and violent activity of which renders it the most fatal 
poison known. 

Circulatory System. — Prussic acid passes very readily into the 
blood, upon which it acts with physical effects variously reported, 
it having been observed that the blood is at first changed to a 
bright red or arterial tint, soon changing to a dark venous color. 
Upon the heart its influence, though in small doses sedative 
through stimulation of the vagus center, in toxic doses is particu- 
larly active, suspending its movements and arresting it in diastole. 

A temporary, yet doubtful, increase, followed by a decline, of 
arterial pressure has been noted. In lethal doses the decrease of 
tension is unquestionable. Observations upon the physiological 
effects of prussic acid have been attended with considerable dif- 
ficulty : a slow and frequently irregular pulse, however, is among 
the authenticated phenomena. By its action on the respiratory 
functions of the red blood-corpuscles the supply of oxygen to the 
circulation is impeded. 

Nervous System. — Medicinal doses have no appreciable effect 
save to occasion a depression of the sensory fibers of the vagus. 
The cerebral effects of large doses are giddiness and stupor, often 
accompanied by total insensibility or coma. Toxic doses produce 
marked cutaneous anesthesia, beginning in the lower extremities, 
caused by paralysis of the sensory ends and sensory tracts. 

The motor mechanism shares in the general influence, which 
causes excessive muscular weakness, resulting from depression of 
the spinal motor areas, the ends of the motor nerves, and the mus- 
cles respectively. 

Respiratory System. — Very small doses of hydrocyanic acid have 
no effect upon respiration. Full or large doses have been observed 



MOTOR DEPRESSANTS. 523 

to render the breathing labored and irregular. Under toxic doses 
the respiration becomes enfeebled, finally ceasing altogether, death 
ensuing from asphyxia due to paralysis of the respiratory move- 
ments by direct action upon the center. It has been noted that 
lethal doses are so quickly fatal that the respirations cannot be 
counted. 

Absorption and Elimination. — As has been remarked, absorption 
takes place with great rapidity, elimination being probably through 
the kidneys, salivary glands, and lungs, the process being accel- 
erated by means of the drug's exceeding volatility. In case of 
poisoning, should death be averted for half an hour there is chance 
of recovery. 

Temperature. — No special influence has been observed. 

Eye. — The pupils are, as a rule, visibly dilated under serious 
dosage, a temporary hemianopia having been also observed in a 
case of poisoning with recovery. 

Untoward Actio7i. — There are no untoward manifestations save 
those described under " Poisoning." 

Poisoning. — The celerity of action characteristic of prussic acid 
is evidenced by the fact that death may be instantaneous, the sub- 
ject falling with a gasp and momentary convulsion, followed by 
immediate collapse. In such cases the countenance is cyanotic, the 
teeth firmly set, the eyes wide open, and the lips covered with 
bloody froth. In less violent cases the symptoms may take the 
form of reduced respiration, impairment of cardiac movements, and 
cerebral disturbance. A third stage is marked by wide dilatation 
of the pupils, loss of consciousness, delirious cries, accompanied 
by strong convulsions, vomiting, incontinence of urine, involuntary 
defecation, and even erections of the penis and ejaculations of 
semen (Hare). In still another stage asphyxia, collapse, and death 
occur in rapid succession. 

Treatmejit of Poisoning. — Owing to the physical action of 
prussic acid upon the blood, artificial respiration is generally pow- 
erless to avert fatal results (Ringer). Efficient antidotes are 
ammonia and its carbonate, to be administered whenever prac- 
ticable. AlcohoHc stimuli may prove of service, yet the fearful 
rapidity of the drug's action renders poisoning by prussic acid 
rarely amenable to systematic treatment. 

A vigorous recourse to alternately warm and cold affusions, 
together with inhalations of ammonia, has been recommended as 
of primary importance. Secondary means of allaying toxic effects 



524 A TEXT-BOOK OF MATERIA MEDICA. 

may be found in the internal administration of chlorine water or 
of potassium carbonate, followed by the sulphates of iron. 

More recently the subcutaneous injection of atropine has been 
suggested as the true physiological antidote (Farquharson), while 
Dr. Antal considers cobalt nitrate the best chemical antagonist. 
So long as the faintest pulsation is discernible no efforts at recovery 
should be remitted. 

Therapeutics. — ExterJtally ajid Locally. — Hydrocyanic acid is 
a valuable antipruritic, being frequently employed to relieve the 
itching of various diseases of the skin, such as eczema, erythema, 
urticaria, priiritits vuIvcb, etc. It is commonly applied in strengths 
of \ fluidrachm (1.8 Cc.) to i ounce (30.0 Cc.) of water. 

Inhalations of a solution containing 3 minims (0.18 Cc.) of 
diluted hydrocyanic acid to 8 ounces (236.6 Cc.) of water at a 
temperature of 120° F. have been recommended by Mackenzie 
and others in asthma and the irritative cough of phthisis. 

Internally. — Its sedative properties render the drug an efficient 
remedy in obstinate vomiting and gastric pain from whatever 
cause. It is also valuable to reheve coughs of a dry, hacking 
nature, whooping cough, and various neuroses of the respiratory 
organs. Macdonald reports a case of night cough of a child that 
yielded promptly to hydrocyanic acid after every other treatment 
had been tried in vain. 

The drug has also been employed in neuralgia and acute mania 
and melancholia. 

In irritable conditions of the heart it serves as a useful palliative, 
and it is also of some value in relieving the distress of irritative 
dyspepsia. 

Contraindications. — Extreme muscular weakness and the last 
stages of valvular heart disease. 

Administration. — Owing to the exceedingly rapid elimination 
of prussic acid the dose should be frequently repeated — every 
hour or two. In the early administration the minimum dose 
should be first prescribed, the amount being gradually increased to 
the maximum or until the patient complains of constriction about 
the throat or other untoward manifestation, when the dosage should 
be discontinued. Whenever a fresh supply is prescribed it is best 
to begin with the minimum dose, owing to the variations in strength 
in the different samples. 

Hydrocyanic acid may be given in syrup, water, or glycerin, or 
in some effervescent draught. 



MOTOR DEPRESSANTS. 525 

Potassii Cyan i dum— Potass ii Cyanidi— Potassium 
Cyanide. 77. 8. r. 

Orig-in. — Prepared by heating in an iron crucible a mixture of 
exsiccated Potassium Ferrocyanide 8 parts and Potassium Carbon- 
ate 3 parts until effervescence ceases. 

Description and Properties. — White, opaque, amorphous pieces, 
or a white, granular powder, odorless when perfectly dry, but in 
moist air exhaling the odor of hydrocyanic acid. The taste is 
sharp and somewhat alkaline, but should be ascertained with great 
care, as the salt is very poisonous. In moist air it deliquesces ; 
soluble in about 2 parts of water and sparingly soluble in alcohol. 
Potassium cyanide should be kept in well-stoppered bottles. 



Dose. — YZ~\ gi'aii^ (0.004-0.008 G 



m. 



Cyanide of potassium differs from hydrocyanic acid, with which 
it generally assimilates, in being less rapid in its action, producing 
dermatitis or eczematous eruption by local application to the epi- 
dermis, and in its possibly fatal results from free contact with 
abraded surfaces. 

The therapeutic uses are practically those of hydrocyanic acid. 

Amyl NTtris— Amyl Nitrltis— Amyl Nitrite. U.S.r. 

Origin. — Obtained by the action of Nitric Acid upon Amylic 
Alcohol — a liquid containing about 80 per cent, of amyl (princi- 
pally iso-amyl) nitrite, together with variable quantities of unde- 
termined compounds. 

Description and Properties. — A clear yellow or pale-yellow 
liquid, of a peculiar, ethereal, fruity odor and a pungent, aromatic 
taste. Almost insoluble in water ; miscible in all proportions with 
alcohol or ether. In alcohoHc solution it gradually decomposes, 
with formation of ethyl nitrite and amylic alcohol. It should be 
kept in small, dark-colored, glass-stoppered bottles, in a cool and 
dark place, remote from lights and fire. 

Dose. — J-i minim (0.03-0.06 Cc.) internally ; for inhalation 1-5 
minims (0.06-0.3 Cc). 

Antagonists and Incompatibles. — The motor excitants antago- 
nize the action of amyl nitrite. 

Synergists. — The motor depressants. 

Physiolog-ical Action. — Externally and Locally. — Its action is 
that of a mild irritant when applied to the skin. 

Internally. — The following actions apply to ingestion or inhala- 
tion of the drug. 



526 A TEXT-BOOK OF MATERIA MEDIC A. 

Digestive System. — No important action has been observed. 

Circulatory System. — Almost immediately after inhalation of 
amyl nitrite there is a marked flushing of the skin, first perceptible 
in the face, doubtless occasioned by dilatation of the capillaries. 
The heart's action is increased and somewhat weakened, and the 
pulse is soft and compressible. The blood-pressure falls very 
markedly, the condition being caused by a paralyzing action upon 
the muscle-fibers found in the walls of the small arterioles, causing 
marked dilatation. The same cause accounts for the change in the 
action of the heart, due to diminution of peripheral resistance. 
Amyl nitrite has no central action. 

The inhalation of large amounts renders the heart very weak, 
toxic doses arresting that organ in diastole. The functional activ- 
ity of the hemoglobin is checked, giving to the arterial and venous 
blood a dark chocolate color. 

Nervous System. — Among the effects are cerebral oppression, 
flushing of the head and face, vertigo, headache, and confusion of 
ideas, with diminished reflex excitability, muscular weakness, and 
unsteadiness of gait, both the voluntary and involuntary muscles 
being relaxed. These actions are due to the depressing influence 
of the drug upon the motor areas of the brain and spinal cord. 

Respiratory System. — Small doses quicken the respiration by 
lowering arterial pressure and possibly by moderate stimulation of 
the center, due to accumulation of carbon dioxide. Immoderate 
or toxic amounts render the breathing slow and labored from 
depression of the respiratory center and arrest of the corpuscular 
action of the blood. 

Absorption and Elimination. — Amyl nitrite is rapidly absorbed, 
being eliminated chiefly by the kidneys, increasing the amount of 
urine, uric acid, and urea excreted. Sugar may frequently be de- 
tected in the urine, probably resulting from the action of the drug 
in dilating the hepatic vessels and increasing the circulation in the 
liver. 

Temperature. — Bodily heat is reduced both in health and in 
fever, due to dilatation of the peripheral blood-vessels and a reduc- 
tion of the oxygen-carrying power of the red blood-corpuscles. 

Eye. — There is marked dilatation of the retinal vessels and 
hyperemia of the papilla, producing chromatopsia of the parti- 
colored variety and hallucinations of vision. These effects are 
usually transitory, and disappear with the ehmination of the drug. 

Uterus. — The uterine muscle is relaxed. 



MOTOR DEPRESSANTS. 52? 

Untoward Action. — In addition to the symptoms described under 
'^'^ Poisoning," there have been noted gastric disturbance, nausea and 
vomiting, dryness of the mouth and trembhng of the Hps, irritation 
of the throat, defective vision, and subjective sensations of color, 
usually yellow vision. 

Poisoning. — The toxic effects of amyl nitrite include an exceed- 
ingly rapid and weak heart, final retardation of the pulse, cyanosis 
of the face, slow and shallow respiration, cold extremities, subnor- 
mal temperature, great muscular weakness, abolished reflexes, 
vertigo, intense headache, and disordered vision. Death results 
from cardiac or respiratory failure. 

Treatment of Poisoning. — Strychnine and digitalis are required 
to sustain the heart ; ergotin or atropine may be administered sub- 
cutaneously, together with cold applications to the head, diffusible 
stimulants, and artificial respiration if necessary. 

Sodii NItris— Sodii Nitrltis— Sodium Nitrite. V. S. JR. 

Origin. — Obtained by heating Sodium Nitrate with Lead, the 
oxygen from the nitrate being abstracted by the lead oxide formed. 

Description and Properties. — White, opaque, fused masses, 
usually in the form of pencils, or colorless, transparent, hexagonal 
crystals ; odorless, and of a mild, saline taste. When exposed to 
the air the salt dehquesces and is gradually oxidized to sodium 
nitrate. Soluble in about 1.5 parts of water; slightly soluble in 
alcohol. It should be kept in well-stoppered bottles. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Splritus GlonoTni— SpTritus Glonoini— Spirit of Glo- 

noin. U.S.I". 

(Spirit of Nitroglycerin.) 
An alcoholic solution of i per cent, of nitroglycerin. 
Origin. — Nitroglycerin is obtained by gradually adding Dehy- 
drated Glycerin to a mixture of Nitric and strong Sulphuric Acid, 
the nitroglycerin formed being washed with water and dilute soda 
-solution to remove all acid. 

Description and Properties. — Nitroglycerin occurs as a clear, 
colorless liquid possessing the odor and taste of alcohol. It 
should be tasted and handled with great caution, since it is apt to 
produce violent headache, whether ingested or applied to the skin. 
It explodes with great force, and should be kept in a cool place, 
remote from Hghts or fire. 



528 A TEXT-BOOK OF MATERIA MEDICA. 

Dose. — 1-3 minims (0.06-0.18 Cc.) of the spirit. 

The actions of sodium nitrite and nitroglycerin are very similar 
to those of amyl nitrite, although they are less prompt, while more 
persistent. Nitroglycerin produces a frontal headache of much 
greater intensity than that caused by amyl nitrite. This is also 
true of sodium nitrite, though the headache it occasions is less 
severe than that resulting from nitroglycerin. 

Both the sodium nitrite and nitroglycerin are preferable to the 
amyl nitrite for internal administration. 

Therapeutics. — Externally and Locally. — The nitrites are not 
used for external purposes. 

Internally. — The property of amyl nitrite in suddenly lowering 
arterial pressure and dilating the arterioles renders it of inestima- 
ble value as a rehef for the terrible precordial pain in angina 
pectoris. 

Epileptic seizures may often be aborted by the instant inhalation 
of amyl nitrite upon the first indication of the aura epileptica. The 
drug has also been successfully employed for the relief of asthma, 
particularly the uremic form, as well as for cardiac dyspnea and 
puerperal eclampsia. 

Like many other motor depressants, it has been used in the 
treatment of tetanus and strychnine-poisoning. It has proved an 
efficient preventive for the chill occurring in vindent malarial fever ^ 
and has served as a valuable antidote m poisoning from chloroform. 

The drug is indicated in all conditions of high arterial tension, 
as in chronic nephritis, etc. It is also beneficial in congestive dys- 
menorrhea. 

The SODIUM NITRITE is used for the same purposes as the amyl 
nitrite, though superior to it for internal administration, as in cases 
of abnormally high ai^terial tension. 

Nitroglycerin is specially adapted for the treatment of cardi- 
opathies occurring after middle life. The tendency to increase of 
peripheral resistance in the vessels after adult life is attained renders 
possible the favorable administration of doses of nitroglycerin intol- 
erable in early life. 

The drug is often of marked benefit in the arrhythmia of slightly 
enlarged and degenerated hearts with arteriosclerosis. It is also 
of considerable value in relieving the pseudo-anginas which are 
frequently a feature of vascular disease. It should be given in 
doses of gio- ^^ TFo grain (0.00032-0.0006 Gm.) twice or four 
times daily. 



MOTOR DEPRESSANTS. 529 

Osier recommends the prolonged administration of nitroglycerin 
in locomotor ataxia, affirming that it lessens the frequency of the 
crises and relieves the neuralgic pains. 

The drug is of use in sciatica, and frequently reHeves obstinate 
hiccougJi. It has been recommended for the same diseases for 
which amyl nitrite is used. 

BROMIDES. 

Potassii Bromidum— Potassii Bromidi— Potassium 
Bromide. TJ. S, P, 

Orig-in. — Prepared by adding Bromine to a solution of Potassa, 
evaporating to dryness, mixing with Charcoal, heating to redness, 
dissolving in Water, and crystallizing. 

Description and Properties. — Colorless or white, cubical- crys- 
tals or granules, odorless, with a pungent, saline taste ; permanent 
in air; soluble in about 1.6 parts of water and in 200 parts of 
alcohol. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

S5dii Brdmidum— Sodii Bromidi— Sodium Bromide. 

TJ. S. JP. 

Origin. — Obtained from a solution of Soda in the same manner 
as Potassium Bromide. 

Description and Properties. — Colorless or white, cubical crys- 
tals, or a white, granular powder, odorless, and with a saline, 
slightly bitter taste. From air the salt abstracts moisture without 
deliquescing. Soluble in 1.2 parts of water and in 13 parts of 
alcohol. It should be kept in well-stoppered bottles. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 

Ammonii Bromidum— Ammonii Bromidi— Ammo- 
nium Bromide. U.S. P. 

Origin. — Obtained by neutralizing Hydrobromic Acid with 
Ammonia or Ammonium Carbonate, evaporating, and crystallizing. 

Description and Properties. — Colorless, transparent, prismatic 
crystals, or a white, crystalline powder, odorless, and of a pungent, 
saline taste; permanent in the air. Soluble in 1.5 parts of water 
and in 30 parts of alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

34 



530 A TEXT-BOOK OF MA TERIA MEDICA. 

Lithii Bromidum— Lithii Brom id i— Lithium Bromide. 

U. S. J>. 

Origin. — Prepared by a solution of Ferrous Bromide and Lithium 
Carbonate, the cool Hquid being evaporated and crystallized. 

Description and Properties. — A white, granular salt, odorless, 
and having a sharp, slightly bitter taste ; very deliquescent. Solu- 
ble in 0.6 part of water and very soluble in alcohol. It should be 
kept in well-stoppered bottles. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Calcii Bromidum— Calcii Bromidi— Calcium Bro- 
mide. U. 8. 1". 

Origin. — Prepared by dissolving pure Calcium Carbonate in 
Hydrobromic Acid and evaporating. 

Description and Properties. — A white, granular salt, odorless, 
of a sharp, saline taste and very deliquescent. Soluble in 0.7 part 
of water and in i part of alcohol. It should be kept in well- 
stoppered bottles. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Zinci Bromidum— Zinci Bromidi— Zinc Bromide. 

U. S. JP. 

Origin. — Prepared by digesting Granulated Zinc in Hydrobromic 
Acid, concentrating the solution, acidulating with Hydrobromic 
Acid, and drying upon a water-bath. 

Description and Properties. — A white, granular powder, odor- 
less, and having a sharp, saline, and metallic taste. Very deliques- 
cent. Readily soluble in water and alcohol. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 



Strontii Bromidum— Strontii Bromidi— Strontium 
Bromide. U. S. JP. 

Origin. — Obtained by neutralizing Hydrobromic Acid with 
Strontium Carbonate, filtration, and evaporation. 

Description and Properties. — Colorless, transparent, hexagonal 
crystals, odorless, and having a bitter, saline taste. Very deHques- 
cent. Soluble in 1.05 parts of water and readily soluble in 
alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



MOTOR DEPRESSANTS. 531 

Acidum Hydrobromicum Dilutum— Acidi Hydro- 
bromici Diluti — Diluted Hydrobromic Acid. 
V. S. P. 

Orig-in. — A liquid composed of 10 per cent, by weight of Abso- 
lute Hydrobromic Acid and 90 per cent, of Water. 

Description and Properties. — A clear, colorless liquid, odor- 
less, and having a strongly acid taste. Miscible in all proportions 
with water and alcohol. It should be kept in glass-stoppered 
bottles, protected from Hght. 

Dose. — 20 minims-2 fluidrachms (1.23-7.39 Cc). 

Bromoformum— Bromoformi— Bromoform 

(Unofficial). 

Origin. — Obtained by the action of Bromine upon equal parts 
of Methylic Alcohol and Caustic Potash. 

Description and Properties. — A colorless, limpid liquid with 
an agreeable odor and sweet taste. Insoluble in water, but soluble 
in alcohol and ether. It should be kept in well-stoppered, dark, 
amber-colored bottles. 

Dose. — 1-5 minims (0.06-0.3 Cc). 



Antagonists and Inconapatibles. — The bromides are antago- 
nized by the motor excitants and cardiac stimulants. The incom- 
patibles are acids, acidulous and metallic salts. Spirit of nitrous 
ether is incompatible with the ammonium bromide. 

Synergists. — Their action upon the brain is enhanced by opium 
and the hypnotics, while the cardiac depressants increase their 
effect upon the circulatory system. 

Physiological Action. — The action of potassium bromide is 
here given, that being the type of the group : later the comparative 
actions of the various members will be considered. 

Externally and Locally. — Potassium bromide is slightly seda- 
tive to mucous membranes when applied locally, lessening the 
reflex irritability, particularly of the pharynx. 

Internally. — Digestive System. — No effect is produced by mod- 
erate amounts. Excessive doses have occasioned a sense of cold- 
ness in the epigastrium, with nausea and looseness of the bowels. 

Circulatory System. — The bromides depress the circulation, 
causing the pulse to become slower, softer, and weaker, and short- 
ening the systole while prolonging the diastole of the heart. The 
caliber of the vessels is diminished, although arterial pressure is 



532 A TEXT-BOOK OF MATERIA MEDICA. 

lowered. Arterial anemia of the brain is present, owing to the 
contraction of the blood-vessels and diminished arterial pressure. 
Toxic doses of potassium bromide cause dilatation of the heart 
and paralysis in diastole. 

The exact points where the bromides act to cause this circula- 
tory depression are undetermined. 

Nervous System. — When given for a long time or under large 
dosage the bromides depress the cerebral cells, producing somno- 
lence, reducing the excitability of the brain, and, if long continued, 
impairing the memory and intellect. 

Under their influence there is marked depression of the motor 
mechanism, resulting in muscular weakness. Every possible point 
of the apparatus is depressed — the cerebral and spinal motor areas, 
the spinal motor tracts, the ends of the motor nerves, and even 
the muscles themselves. 

Bromides also lessen greatly the reflex excitabiHty of the spinal 
cord. As in their action upon the motor mechanism, they depress 
every part of the reflex apparatus — the ends of the afferent and 
efferent nerves and the reflex center wherever it may be. 

The sensory mechanism is therefore impaired, causing dimin- 
ished sensibility of the skin and mucous membranes. 

The functional activity of the sexual organs is considerably less- 
ened by these drugs. 

Respiratory System. — Under full doses the respirations are 
slower and shallower, owing to depression of the respiratory 
center, paralysis of which usually causes death, although fatal 
paralysis may affect the heart because of the poisonous influence 
of the potassium upon the cardiac muscle. 

Absorption and Elimination. — The bromides are very rapidly 
absorbed, having been found in the urine ten minutes after their 
ingestion (Dujardin-Beaumetz), and are quickly eliminated, chiefly 
by the kidneys, increasing the flow of urine, and also by the skin, 
saliva, intestinal and mammary glands, and the bronchial mucous 
membrane. The sulphur and nitrogen in the urine are increased 
and the amount of phosphorus decreased. 

Notwithstanding the rapid elimination of the bromides, under 
prolonged administration they tend to accumulate in the system, 
being found abundantly in the nerve-centers. 

Temperature. — Immoderate doses cause a reduction of temper- 
ature, due to depression of the circulation and lessening of tissue- 
change. 



MOTOR DEPRESSANTS. SZZ 

Eye. — There may occur dilatation of the pupil, conjunctival 
catarrh, diplopia, amblyopia, dimness of vision, and dilatation of 
the retinal blood-vessels. 

Uterus. — A diminution of the catamenia may sometimes be 
present. 

Untoward Actio/i.^The susceptibility of individuals to the un- 
toward action of the bromides is extremely variable. The symp- 
toms observed are — gastric uneasiness with eructation, nausea and 
vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, 
hoarseness and cough, acute coryza and conjunctivitis, offensive 
breath, dysuria, diminished sensibility of the genito-urinary mucous 
membrane, and a variety of cutaneous eruptions. 

Poisoning. — Bro7nism,diS the symptoms of poisoning are termed, 
may be divided into acute and chronic. 

Acute broniisin, resulting from a single toxic dose, is manifested 
by violent frontal headache, great muscular weakness, incoordi- 
nation of movements, abolition of reflexes, somnolence, slow and 
shallow breathing, subnormal temperature, lustreless eyes, and 
very slow and weak pulse, death resulting from either respiratory 
or cardiac failure. 

Chronic bromism, caused by prolonged use of the bromides, is 
characterized by mental apathy, constant drowsiness, hallucination 
or melanchoHa, considerable cutaneous anesthesia, muscular weak- 
ness, poor circulation, cold extremities, marked anemia, impairment 
of the sexual function, deranged digestion, and cutaneous eruptions 
of various forms collectively designated as ** bromine acne." 

Treatment of Poisoning. — The drug should be immediately 
withdrawn and methods adopted to hasten elimination, such as the 
administration of diuretics, cathartics, etc. Tonics, such as strych- 
nine, iron, and the cardiac stimulants, should be given, while exer- 
cise and change of scene may counteract the psychical symptoms. 

It is claimed that the daily administration of Fowler's solution 
causes a rapid disappearance of the bromine eruption. 

Comparative Action of the Bromides. — Potassium bromide 
contains 66 per cent, of bromine. It is the least hypnotic and most 
toxic to the heart and muscular system. 

Sodium bromide, 78 per cent, of bromine, is more hypnotic, but 
much less toxic, than the potassium salt. Its effect upon the cir- 
culation is the most pronounced of all the bromides. 

Ammonium bromide is less toxic and more stimulating than 
potassium bromide, though resembling it in other respects. 



534 



A TEXT-BOOK OF MA TERIA MEDIC A. 



Lithium bromide is the richest in bromine, containing 92 per 
cent., and is probably the most hypnotic of all. Its action more 
nearly resembles that of the sodium salt. 

Calcium bromide, while resembling them in its action, is less 
energetic than the other bromides. 

Zinc bromide is the most irritant, and is supposed to possess 
both tonic and sedative properties. 

Strontium bromide is the mildest of all, being less prone to 

cause bromism. 

Diluted hydrobromic acid in its action resembles the bro- 
mides, though much less depressant than the potassium salt, and 
less likely to occasion symptoms of chronic poisoning. 

Therapeutics. — Externally and Locally. — Pharyngitis is relieved 
by a gargle containing potassium bromide and potassium chlorate. 
A solution of potassium bromide diminishes the sensibility of the 
throat, so that examinations are more easily made. A solution of 
4 parts of potassium bromide in 20 parts of glycerin affords a 
soothing lotion in painful hemorrhoids. It 
is asserted that the powdered salt has been 
dusted over indolent ulcers with benefit. 

Internally. — The bromides are especially 
useful in allaying excessive brain activity, the 
insomnia (particularly the sleeplessness de- 
pendent upon nervous excitement, exhaus- 
tion, and irritability) and headache of cerebral 
congestion yielding readily to these remedies. 
They are undoubtedly the most efficient 
medicinal agents for the relief of epilepsy, 
being given either alone or in combination 
with some vegetable bitter. Fere combines 
with them an intestinal antiseptic, asserting 
that the union lessens the tendency to bro- 
mism. Bechterew highly recommends a com- 
bination of the bromides with Adonis vernalis. 
Being such marked depressants of the 
reflex centers, they are of decided benefit in 
nervous spasmodic disorders, and particu- 
larly valuable in infantile convulsions. 
During dentition children suffer from various disturbances due 
to irritation of the dental nerve — convtdsions, cough, indigestion, 
diarrhea, strabismus, etc. — in all of which the bromides, being 




Fig. II. — Diagram showing 
how irritation of the dental nerve 
in teething, by stimulating the 
sensitive reflex mechanism of the 
infant, may produce strabismus 
{B), cough (Z>, K), indigestion 
(Z), diarrhea {M), and convul- 
sions (iV). 



MOTOR DEPRESSANTS. 535 

powerful depressants of the reflex mechanism, prove of great value. 
(See Diagram 1 1 .) 

Whenever there is increased reflex excitabiHty the bromides are 
indicated. They are therefore valuable in the reflex disturbances of 
the menopause, spasmodic asthma, laryngismus strididus, whooping 
cough, and other coughs of reflex origin. They have also been used 
in tetanus and strychniiie-poisoning. 

Excessive nervous irritability is quickly relieved by these reme- 
dies, either singly or in combination with some of the antispas- 
modics, such as asafetida, valerian, etc. 

Because they depress the sexual mechanism they are of decided 
benefit in spermatorrJiea of the plethoric or in the condition arising 
from irritation of the deep urethra. 'Menorrhagia resulting from 
excessive ovarian excitement is frequently relieved by these agents, 
while nymphomania and delirium tremens are often greatly benefited 
by full doses of the bromides. 

The AMMONIUM BROMIDE has been employed with benefit, it is 
said, in diabetes of nervous origin. Cerebral vondting and the 
vonuting of pregnancy 2.XQ sometimes singularly amenable to the 
influence of the bromides. 

The author is quite partial to a combination of sodium bromide, 
spirit of nitrous ether, and tincture of aconite, in anise water, as a 
remedy in acute febrile attacks of children with delirium. Small 
doses are given at frequent intervals until there is a decided im- 
provement in the symptoms. 

The bromides are claimed to be of value in acute and musctdar 
rheumatism. The ijthium salt is undoubtedly of service in these 
cases and in the uric-acid diathesis. 

The sedative action upon the circulatory apparatus exerted by 
the bromides renders them valuable in cardiac irritability when not 
due to anemia. They are particularly useful in quieting the heart's 
action in exophthalmic goiter. 

Augagneur advises the use of the bromides together with the 
iodides in the treatment of syphilis, believing that their administra- 
tion prevents such untoward manifestations as dysphonia, aphonia, 
or dyspnea in laryngeal syphiHs. 

The STRONTIUM bromide is highly recommended m. fermentative 
dyspepsia due to decomposition of food. 

Bromoform ranks to-day superior to all other remedies in the 
treatment of whooping cougJi, an overwhelming amount of authori- 
tative evidence tending to prove that the drug not only greatly 



53^ A TEXT-BOOK OF MATERIA MEDICA. 

curtails the duration of the disease, but mitigates the severity of 
the paroxysms and renders them less frequent. 

Bromoform has also been highly recommended in acute 7iia7iia 
and deliriimi tremens. 

Diluted hydrobromic acid is used for the same purposes as 
the bromides, some clinicians preferring it to the latter to quiet the 
delirium of simple continued fevers. It is employed extensively 
to relieve the symptoms of cinchonism. 

Contraindications. — The bromides are contraindicated in con- 
ditions of great debility, anemia, or fatty or weak heart with low 
arterial pressure. 

Administration. — The bromides should be given in solution, 
and when long continued, as in the treatment of epilepsy, they 
should be accompanied by restorative agents. Carbonated waters, 
milk, and aromatic elixir serve as efficient vehicles to disguise the 
taste of these salts. 

Children acquire a remarkable tolerance for the bromides, so 
that large doses may be given them with but little danger. 

Bromoform may be dropped into a spoonful of water and ad- 
ministered in this simple manner, or it may be dissolved in gly- 
cerin. P. W. Bedford has originated a formula which makes an 
exceedingly palatable and perfect solution : 

Bromoformi, Tltxvj (i.o Cc.) ; 

AlcohoHs, 

Tincturae Cardamomi Compositae, da. f 3ij (7.39 Cc.) ; 

Glycerini, q. s. ad. 5ij (60.0 Cc). 

Each fluidrachm contains i minim (0.06 Cc.) of bromoform. 

The diluted hydrobromic acid should be given in water or 
syrup. 



GROUP VIII.— CARDIAC STIMULANTS.^ 

Cardiac remedies may be divided into Cardiac Tonics, Cardiac 
Stiniidants, and Cardiac Sedatives or Depressants. The grouping 
is a rational one, both from a clinical and a physiological point of 
view, although the Cardiac Sedatives are at present much more 

1 The author is indebted to Joseph M. Patton, M. D., Professor of Medicine in the 
Chicago Polichnic, for valuable assistance in preparing the present group, his observa- 
tions on therapeutics being occasionally cited verbatim. 



CARDIAC STIMULANTS. 537 

limited in their clinical application than they were a few years 
ago, being used principally in sthenic fevers with excessive cardiac 
action. 

Cardiac Tonics. — By these are implied those drugs which add 
tone to the cardiac muscle and the nervous mechanism of the heart, 
increasing the nutrition of that muscle, and consequently augment- 
ing its capacity for work. 

The cardiac tonics have Httle or no effect upon the dynamic 
force exerted through the contraction of the heart-muscle, herein 
lying their essential distinction from cardiac stimulants, which affect 
per se the muscular contractile force. 

The proper period for the employment of cardiac tonics antici- 
pates that where the exhibition of cardiac stimulants becomes neces- 
sary. They are, moreover, prophylactic against the latter contin- 
gency, preventing the development of a hyposystolic condition of 
the heart. They are also indicated subsequent to the temporary 
use of cardiac stimulants to improve the nutrition of the heart and 
maintain the beneficial results of stimulation. 

Cardiac tonics should be given in small doses and the adminis- 
tration prolonged. 

The principal members of the group are — strychnine, the 
IODIDES, ARSENIC, and IRON, to whicli should be added mercury in 
small doses. The most useful are strychnine and the iodides, and 
they are well adapted for combined administration. 

Since most cases requiring the exhibition of this class of 
remedies occur after middle life, they are especially benefited by 
the action of strychnine on the cardiac nervous system and the 
increased nutrition to the heart-muscle through the effect of the 
IODIDES on the smaller vessels. The progressive tendency of after- 
lifetime toward loss of elasticity and a contraction of the smaller 
arteries is opposed by the action of the iodides in dilating these 
vessels. 

The advantage of prolonged administration of mercury in 
small doses in chronic cardiopathies during or after middle life 
is probably due to the stimulating effect of the drug on the func- 
tions of elimination. 

Mercury is adapted to nearly all senile cardiopathies, particu- 
larly in conditions of general vascular sclerosis, the most desirable 
form being the bichloride or red iodide in doses of -g^ grain (0.001 
Gm.) three times daily. 

Arsenic may be used in the form of the arsenic iodide or as 



538 A TEXT-BOOK OF MATERIA MEDICA. 

Fowler's solution. It is of special value in anemic conditions 
associated with cardiopathies in young persons. 

The most eligible form of iron for cardiac patients, especially 
after middle life, when elimination is an important consideration, is 
the LiQ. FERRi ET AMMONii ACETATis (Basham's mixture), or the 
so-called tasteless tincture of iron, with which the tincture of 
nux vomica may be well combined. 

The physiological action and further medical uses of these 
cardiac tonics are more fully described under their respective 
heads. 

Cardiac Stimulants.- — As cardiac stimulants are designated 
those drugs endued with the specific property of lengthening and 
invigorating the contraction of the cardiac muscle. This effect 
would necessarily be more or less temporary, and, while some 
permanent benefit may be derived from improved nutrition result- 
ing from a better blood-supply afforded by these agents, they are 
adapted only for passing administration and are not true cardiac 
tonics. 

The general indication for the employment of this class of 
remedies rests in the presence of dynamic insufficiency of the 
muscle, which may be either actual or relative, as is the case of 
increased peripheral resistance to the blood-current. In the latter 
instance it is evident that the extracardiac obstruction must be 
removed before the salutary effects of cardiac stimulants can be 
obtained. 

It is in actual failure of the contractile force of the cardiac 
muscle that these stimulants display their most beneficial influence. 
This failure is due to a greater quantity of blood in the cavity than 
the muscle is able to cope with. The amount of dynamic force 
required at each contraction to expel this quantity is so great that 
the muscle is unable to withstand the pressure without stretching, 
and consequently dilatation is developed. Here the favorable 
action of cardiac stimulants is manifest, since by stimulating the 
muscle to more vigorous contraction the equilibrium of the circu- 
lation is maintained until compensatory increase in muscular 
power has had time to develop. 

The principal cardiac stimulants are — Digitalis, Strophan- 
THUS, Caffeine, Alcohol, Ammonia, Spartein, Cactus grandi- 
flora, Adonis vernalis, and Convallaria, all fully described 
under their respective heads. 

In addition to these, strychnine, opium, and nitroglycerin are 



CARDIAC STIMULANTS. 539 

sometimes used as cardiac stimulants. They are fully described 
under their respective heads. 

Digitalis is the typical medicament of the group, after many 
years still retaining its place as the most trustworthy and generally 
useful cardiac stimulant. 

Digitalis— Digitalis— Dig-italis. Z7. 8. JP. 

(Fox- GLOVE.) 

Origin. — The leaves of Digitalis purpurea L., collected from 
plants of the second year's growth. The plant is a biennial, 2-5 
feet (0.6-1.5 M.) high, indigenous in Southern and Central Europe, 
and growing wild as far north as Norway. It is also found in 
Madeira and the Azores, and is well known everywhere as an 
ornamental garden plant. 

Description and Properties. — From 4 to 12 inches (10-30 
Cm.) long, ovate or ovate-oblong, narrowed, with a petiole, crenate, 
dull green, densely and finely pubescent, wrinkled above, paler and 
reticulate beneath, midrib broad near the base ; odor slight, some- 
what tea-like ; taste bitter, nauseous. The leaves of mullein, Inula 
coryza and hmla hclcniiun, are sometimes mixed with those of 
fox-glove. 

It is yet undecided what the chief constituents are. Five prin- 
ciples, however, have been isolated, neither of which represents the 
crude drug. They are — digitalin (soluble in alcohol, insoluble in 
water) ; digitalein (soluble in water and alcohol) ; digitoiiin, the 
most active diuretic principle (soluble in water, insoluble in alcohol) ; 
digitin, an inert substance ; and digitoxin, the most active con- 
stituent (insoluble in water and sparingly soluble in alcohol). All 
save digitoxin are glucosids. 

Dose. — J-2 grains (0.03-0.12 Gm.). 

Official Preparations. 

Extractum DigitSlis — Extract! Digitalis — Extract of Digitalis. — Dose, \-\ 
grain (0.01-0.03 Gm.). 

ExtrSctum Digitalis Fluidum— Extracti Digitalis Fluidi— Fluid Extract 
of Digitalis. — Dose, Yz-i minims (0.03-0.12 Cc). 

Infusum Digitalis — Infiisi Digitalis — Infusion of Digitalis (i^ per cent.). — 
Dose, 1-4 fluidrachms (3. 7-1 5 Cc). 

Tinctura Digitalis — Tincturae Digitalis — Tincture of Digitalis (15 per cent.). 
— Dose, 5-20 minims (0.3-1.2 Cc). 

Unofficial Preparations. 

Digitalinum — Digitallni — Digitalin. — Description and Properties. — An amor- 
phous, yellowish-white, crystalline powder or scales, or light, white ciystalline tufts of 



540 A TEXT-BOOK OF MATERIA MEDIC A. 

needles, odorless and of an intensely bitter taste. Insoluble in water, soluble in 
alcohol. 

Dose. — x7o"~3"V g^'^ii'i (0.0006-0.002 Gm.). 

Digitoxin — Digit6xin — Digitoxin. — Description and Properties. — A white, crys- 
talline body, of a bitter taste ; insoluble in water, soluble in chloroform. 

Dose. — 2o"^~T^o" gJ'^iii (0.0003-0.0006 Gm.). 

Antagonists and Incompatibles. — The most complete antag- 
onist is saponine, the active constituent of Saponaria officinalis. 
The cardiac depressants antagonize the action of digitaUs upon the 
heart, morphine and the emetics possessing a similar property, 
though in less degree. 

The incompatibles are the ferric chloride and sulphate, prepara- 
tions of cinchona, tannic acid and preparations containing it, and 
the subacetate and acetate of lead. 

Synergists. — The cardiac action of digitalis is aided by other 
members of the group (cardiac stimulants), and also by belladonna 
and ergot. 

Physiolog'ical Action. — Externally and Locally. — Digitalis pos- 
sesses mild sedative properties when locally applied, and is readily 
absorbed by the skin. 

Internally. — Digestive System. — Small doses ordinarily produce 
no effect upon the stomach. Large doses act as a gastro-intestinal 
irritant, exciting nausea, vomiting, and diarrhea. These effects may 
follow the prolonged administration even of small doses. 

Circulatory System. — The principal effects of digitalis are upon 
the circulatory apparatus, the action of the drug varying according 
to the size of the dose. Medicinal doses cause the pulse to beat 
stronger, firmer, and slower, the strength of the beat being due to 
stimulation of the cardiac ganglia and the muscular fibers them- 
selves. Arterial pressure is raised through stimulation of the vaso- 
motor center in the medulla and the ganglia situated in the mus- 
cular coats of the blood-vessels, causing a contraction both of the 
arteries and arterioles. 

This increase of arterial tension gives firmness to the pulse-beat : 
its slowness is due to lessened frequency in the heart-beat, caused 
by stimulation of both the roots and ends of the cardiac vagus, 
and consequent lengthening of the diastolic period. 

Large doses may cause the pulse to beat faster and still increase 
arterial pressure. The rapid cardiac action is due to over-stimula- 
tion of the pneumogastric nerve and consequent exhaustion. The 
inhibition being removed and the heart acting under the influence 



CARDIAC STIMULANTS. 541 

of the sympathetic nerves, its beats are more frequent. The arterial 
tension is still high, because the mechanism presiding over the 
caliber of the arterioles is not so easily over-stimulated as the 
vagus, and contracts still more, which, with the increased action of 
the heart, tends to increase arterial tension. 

Toxic doses render the pulse very rapid, irregular, soft, and 
weak. The irregular action of the heart is due to exhaustion of 
the motor gangha in the heart-muscle from over-stimulation, one 
of the functions of these gangha being to induce regular cardiac 
contraction. 

The pulse is soft because of lowered arterial pressure, the 
arterioles under these doses being dilated from exhaustion of the 
vaso-motor mechanism. The weak pulse is due to exhaustion of 
the muscular power of the heart from over-stimulation. Death 
usually occurs with stoppage of the heart in diastole. 

Nervous System. — No effect is produced by medicinal doses. 
Immoderate doses, however, occasion headache and vertigo, to- 
gether with lessened reflex activity — by stimulating Setchenow's 
inhibitory center and depressing the motor nerves. The muscles 
themselves may be paralyzed, the sensory nerves being unaffected. 

Respiratory System. — Medicinal doses have no effect upon the 
system ; toxic doses slow the respiration. 

Absorption and Elimination. — Digitalis is rapidly absorbed and 
slowly eliminated, probably by the kidneys, under certain conditions 
increasing the urinary flow, and many authorities claim the amount 
of solids excreted is augmented, except urea and uric acid, which 
are diminished. 

Its diuretic action is due to the increase of blood-pressure in 
the glomeruli of the kidneys, being therefore more pronounced in 
conditions of low arterial pressure. Very large doses, instead of 
increasing the amount of urine, may diminish or even wholly 
suppress it. 

The action of digitalis upon the kidneys is elucidated by the 
diagram (Fig. 12). 

It is claimed that two constituents of digitalis, digitoxin and 
digitalein, dilate the renal arteries, while digitaHn has no effect 
upon the renal blood-vessels, but contracts those of the general 
system. 

The true action of digitahs, however, is as yet undetermined. 
It is an extremely complex drug, and its various constituents pos- 



542 



A TEXT-BOOK OF MATERIA MEDICA. 



sess different properties when therapeutically employed. It is 
obvious, therefore, that the action upon the heart and kidneys will 
depend largely upon the particular preparation administered. 

Temperature. — Medicinal amounts have no appreciable effect 




Fig. \2..—A, heart; B, veins; C, efferent vessels; D, artery; E, capillary system; F, afferent 
vessels ; G, kidney; H, glomerules of the kidney. 

Upon the temperature ; large doses cause a reduction of bodily 
heat in febrile conditions, while toxic doses reduce temperature 
even in health. 

The action of digitalis upon the circulatory system is retarded 
by high temperature. 

Eye. — Medicinal amounts have no effect. Large or poisonous 
doses may cause dimness of vision, amblyopia, diplopia, or mydri- 
asis. In a case of poisoning by digitaHs recorded by Jeanton there 
was xanthopsia for two days. 

Uterus. — Large doses stimulate contraction in the uterine 
muscles. 

Untoward Action. — Erysipelatous and papular eruptions have 
been produced by the drug, there having been also observed 
nausea and a feeling of weakness in the stomach, dimness of vision, 
headache, heaviness of the head, sleeplessness, and debility. 

Poisoning. — Toxic symptoms may occur either from the inges- 
tion of a single poisonous dose or the accumulation of the drug 
under prolonged administration. There are marked disturbances 
of the gastro-intestinal tract, abdominal pains, vomiting and 
purging, a rapid, irregular, and compressible pulse — often imper- 
ceptible at the wrist — and syncope, more frequently occurring 
when the patient is raised up. 

Other symptoms are — feeble respiration, dilated pupils and 
occasionally double vision, headache, dehrium and stupor, and 



CARD/ AC STIMULANTS. 543 

possibly convulsions just before death, which occurs from cardiac 
failure. Digitalis is not a rapid poison, the fatal collapse being 
usually deferred from ten to forty- eight hours. 

Treatment of Poisoning. — Lavage of the stomach should be 
immediate, emetics being too depressing if the heart is already 
affected by the poison. A solution of tannic acid should be intro- 
duced into the stomach as the best chemical antidote. Diffusible 
stimulants may be required, the horizontal position should be 
maintained, and external heat applied, particularly to the abdomen. 

Saponin^ aconite, and opium are physiological antidotes, and 
one or more of them should be employed. 

Therapeutics. — Externally and Locally. — Poultices made of 
DIGITALIS LEAVES havc been employed with some success in acnte 
inflammation of the joints, and when applied over the loins act as 
an efficient sedative and diuretic in congestion of the kidneys. 

Internally. — Digitalis is one of the most important drugs known 
to medicine. The remedy is indicated in deranged conditions of 
the circulatory system itself, and, moreover, where, although the cir- 
culatory mechanism be normal, an abnormal state of other organs 
may be improved by changing the circulation in them. Digitalis 
is indicated in any case where there is actual failure in the dynamic 
power of the heart-muscle, irrespective of the nature of any 
primary valvular lesion inducing the hyposystolic condition. 

Of course the rational use of the drug presupposes the absence 
of extensive fatty degeneration or interstitial myocarditis, since, 
should these conditions be advanced, there is danger of producing 
permanent asystole. It is difficult to estimate the integrity of the 
heart-muscle, and many cases presumably intolerant of the drug 
bear digitalis well. 

There has been considerable objection to the use of digitalis 
in cardiac ataxia resulting from aortic regurgitation, on the ground 
that the latter action is more forcible and extensive under its 
influence. 

This argument is generally advanced by those who believe 
that the dilatation of the left ventricle in aortic regurgitation is 
due mainly to the effect of the counter-current upon the relaxed 
ventricle while in diastole. The regurgitant stream has probably 
little or no influence in producing the dilatation, since the cubic 
area of the ventricular cavity covered by the stream is so much 
greater than that of its inlet that it is difficult to see how great 
pressure could be exerted in this way. The phenomenon is, rather, 



544 A TEXT-BOOK OF MATERIA MEDIC A. 

mainly due to the greater pressure necessary to empty the ventricle 
of its superfluous blood. 

That there is any marked increase in the amount of regurgi- 
tated blood through reduced action of the heart is not sustained 
by the clinical results of the administration of digitahs in cases of 
aortic regurgitation. Indeed, they respond to the use of the drug 
as promptly as any other lesion, save that it is at times necessary 
to ^\N^ larger doses, often twice the quantity administered in other 
valvular lesions. 

As to the cumulative effect of digitahs, so much feared by the 
older writers on its action, the evil may be ascribed to improperly 
selected cases or faulty administration. Under proper conditions 
the drug may be given for months without ill effect. 

It is asserted that the action of digitalis may be manifested for 
some time upon discontinuance of a brief dosage. 

With regard to the specific effect of the drug upon the heart- 
muscle this is not true, since the influence of the drug lasts but 
a few days, indirectly, through the additional muscle-power devel- 
oped during a few weeks' administration. During or after middle 
life, if the vascular tension be increased, and especially if there be 
any sclerosis of the vessels, the administration of digitalis should 
be combined with that of vaso-dilators, to prevent contraction of 
the vessels and consequent increase of peripheral resistance. Of 
these adjuncts, opium is generally the most useful, from 2 to 5 
drops (0.1-0.3 Cc.) of the deodorized tincture or ^^q- to -^ grain 
(0.003-0.005 Gm.) of morphine sulphate being given (Patton). 

In mitral regurgitation digitalis is an exceedingly efficient rem- 
edy. As shown in the diagram (Fig. 13), there is a deficiency of 
blood in the systemic arteries, and consequently an over-accumula- 
tion in the pulmonary vessels and systemic veins. Owing to this 
venous hyperemia, there is congestion of the lungs, stomach, liver, 
and the entire digestive tract, together with the attendant symp- 
toms — dyspnea, bronchitis, deranged digestion, constipation, edema, 
etc. 

Digitalis by improving the pumping power of the heart equalizes 
the circulation, fills the systemic arteries, and relieves the venous 
congestion with its accompanying symptoms. 

Digitahs is valueless in the presence of compensatory hyper- 
trophy, but after dilatation occurs is wonderfully effective, the size 
of the heart being often perceptibly diminished by a proper admin- 
istration of the drug. 



CARDIAC STIMULANTS. 



545 



Digitalis may act indirectly as a tonic by improving the nutri- 
tion of the heart through the prolonged diastole and contraction 
of the cardiac muscle it occasions. The longer the period of dia- 
stole, the more time is allowed for the coronary arteries to fill and 
nourish the heart by the better blood-supply. The increased arte- 
rial tension produced by the 
drug causes the blood to be 
sent into the coronary arteries 
with greater force during the 
cardiac diastole. 

The forcible contraction of 
the heart occasioned by this 
drug expels the blood from 
the veins of the cardiac mus- 
cle, improved nutrition of the 
muscle resulting from this me- 
chanical action. 

The prolonged diastole pro- 
duced by digitalis allows the 
heart to rest, conserving its 
energy and rendering the drug 
of great value in many acute 
diseases accompanied by ex- 
cessive cardiac action. 

In many valvular diseases 
of the heart there is marked 
irregularity, an irritability in 
than the mere leakage of blood. Digitalis by stimulating the 
vagus and motor ganglia reduces the irritative influence, causing 
the heart to beat more regularly. The drug is therefore of great 
service in exophthalmic goiter. 

In any condition of low arterial tension, whether resulting from 
hemorrhage, general debility, or whatever cause, digitalis by increas- 
ing the force of the heart and raising arterial pressure serves a 
useful purpose. 

In collapse from sJiock, poisoning, or cholera, where the great 
veins are dilated, it has proved an efficient agent. 

The functional activity of the various organs in anemia and 
other deranged conditions of the system may be improved by the 
administration of this remedy. 

The circulation being improved, there is increased absorption 

35 




Fig. 13. — Diagram showing how digitalis relieves 
the sj-mptoms of mitral disease : i, right heart ; 2 
left heart ; 3, lungs ; 4, systemic arteries ; 5, capil- 
laries : 6, systemic veins; 7, liver; 8, intestines; 

9, lymphatics. 



its action being often more serious 



546 A TEXT-BOOK OF MATERIA MEDICA. 

of fluid from the tissues, as well as greater circulation of fresh 
intercellular fluid, favoring combustion and functional activity, 
while the waste products are more readily removed. This action 
renders digitaHs valuable as a tonic. 

In the second stage of p7ieumonia it is of the greatest importance, 
being of use here to stimulate the contractile force of the cardiac 
muscle when the intraventricular pressure becomes stronger than 
the unaided muscle can resist, and dilatation is imminent if not 
already begun. The main indication for the drug is the increase in 
intensity of the second pulmonic sound. 

In congestion of the lungs during the course of exhausting fevers, 
such as typhoid, and in the first stage of meningitis, bronchitis, cellu- 
litis, etc. before transudation takes place, it is considered by many 
physicians to be a valuable remedy in relieving the venous stasis. 

Digitalis is singularly beneficial in scarlet fever to slow the 
heart and by its action upon the kidneys prevent renal com- 
pHcations. 

Mr. Jones was among the first to recommend large doses of 
digitalis in delirium tremens. The author has found it to be won- 
derfully effective in this condition, particularly where there is low 
arterial pressure, at the same time having observed that smaller or 
stimulant doses are more beneficial than the larger ones suggested 
by Jones. The drug is undoubtedly less serviceable in delirium 
tremens characterized by high arterial tension. 

Digitalis has been successfully employed in acute mania and 
epilepsy, Gowers recommending it in the latter disease as an adju- 
vant to the bromides, associated with belladonna. It is fair to 
state that in maniacal conditions the preponderance of testimony is 
in favor of large doses — \ to 4 fluidrachms (1.8-15. Cc.) of the 
tincture. 

Through its action in contracting the caliber of the arterioles 
digitalis serves as a valuable hemostatic in hemoptysis, epistaxis, 
meiiorrhagia, etc. 

The drug is thought to enhance the influence of ergot in post- 
partum heinorrhage, and when associated with iron it is of value in 
purpura hcsmorrhagica. 

According to Harold Henry, digitalis and strychnine have 
proved beneficial in the diarrhea co7nplicating remittent fever. 

The drug, combined with ergot or potassium bromide according 
to the indications, has been successfully employed in spermatorrhea 
and nocturnal emissions. 



CARDIAC STIMULANTS. 547 

It is said that absorption of pleuritic effusion is hastened by the 
continued administration of digitalis. 

Clifford Allbutt recommends it in sufficient doses to reduce the 
pulse to 45 or 50 in aneurysm. This method of treatment, how- 
ever, has not been widely adopted. 

Digitalis is one of the best antidotes to aconite- and muscarine- 
pois oiling. 

The remedy is invaluable as a diuretic to relieve cardiac or reital 
dropsy, its efficiency being more apparent in the former variety, 
although acute renal dropsy usually yields to its influence. Should 
the renal structure be impaired, the drug is less serviceable, al- 
though, when combined with other appropriate remedies, it is 
decidedly beneficial in chronic Bright s disease with cardiac dilata- 
tion. In the early stages of the malady, accompanied by cardiac 
hypertrophy and high arterial tension, it is doubtful whether 
digitalis is indicated, either alone or in combination. 

In conclusion, it should be stated that digitalis is recommended 
by all authors in every valvular disease of the heart, with the pos- 
sible exception of aortic regurgitation, some writers supposing it to 
be harmful in this condition because of the prolonged diastole it 
occasions. 

The author's experience leads him to differ with those who con- 
sider aortic insufficiency a contraindication to the use of this 
important drug. The excellent and logical reasons advanced by 
Professor Patton for the use of the remedy in aortic regurgitation 
coincide entirely with the author's views. 

Contraindications. — Digitalis should not be given when there 
is marked degeneration of the heart-muscle or of the arterial 
walls. In simple hypertrophy, apoplexy, high arterial pressure, 
or vascular excitement the use of the drug is inadvisable. Many 
physicians regard aneur^^sm as a contraindication to the use of 
digitalis. 

Administration. — Any of the official preparations may be given, 
or the powdered leaves in pills or capsules — not at too frequent 
intervals, however, from four to eight hours elapsing between the 
doses, lest the drug accumulate in the system, producing poisonous 
symptoms. 

When digitalis has been administered for some time to a patient 
suffering from ascites, and the fluid is removed by paracentesis, 
poisoning may ensue. It is well, therefore, to discontinue the 
remedy for two or three days before tapping the patient. 



548 A TEXT-BOOK OF MA TERIA MEDICA. 

The rapidity of the drug's action upon the heart depends upon 
the presence or absence of a febrile state. The stimulant action 
upon the heart is usually observable in from twenty-four to thirty- 
six hours. The effects of the drug commonly continue from three 
to seven days after its discontinuance. 

The powdered digitalis, though the most irritant to the stom- 
ach, fully represents the drug, which is true of none of the prepa- 
rations. 

Of the active constituents, digitalin is usually preferred, notwith- 
standing its uncertain action. 

The infusion of digitalis, being an aqueous preparation and con- 
taining, therefore, a larger proportion of digatonin, is superior for 
diuretic purposes ; while the alcoholic preparations, Hke the fluid 
extract and tincture, being richer in digitalin and digitalein, are 
preferable when an action upon the heart is desired. 

Ordinarily, therefore, digitalis should be given in solution, the 
tincture and infusion being the most reliable preparations ; care 
being taken in the selection of the crude drug upon the character 
of which the strength of the preparation depends. 

In uncomplicated cases of cardiac failure, the result of valvular 
lesion, the tincture is most ehgible. In cardiac failure associated 
with, or resulting from, kidney lesions the infusion, combined with 
some other diuretic, should be used. 



Strophanthus— Strophanthi— Strophanthus. 

77. H. B. 

Origin. — The seed of Strophanthus hispidus D. C, deprived of 
its long awn. The plant is a woody climber, ascending to the tops 
of high trees, from which it hangs in festoons. It is found in 
tropical Africa, where it is used to prepare an arrow-poison termed 
konibi. 

Description and Properties. — The seeds are about f inch 
(15 Mm.) long and |- to |- inch (4-5 Mm.) broad, oblong-lanceolate, 
flattened and obtusely-edged, grayish-green, covered with appressed 
silky hairs, one side extending into the attenuated, pointed end ; 
kernel white and oily, consisting of a straight embryo having two. 
cotyledons, and surrounded by a thin layer of perisperm ; nearly 
inodorous ; taste very bitter. 

Strophanthus contains a glucosid, strophanthine upon which its 
medicinal properties depend. It also contains kombic acid. Another 



CARDIAC STIMULANTS. 549 

active principle, ouabain, is obtained from a similar species of 
Strophanthus. 

Official Preparations. 

Tinctura StrophSnthi — Tincturae StrophSnthi — Tincture of Strophanthus 

(5 per cent.). — Dose, 2-10 minims (0.12-0.6 Cc). 

Unofficial Preparations. 

StrophSnthin — Stroph^nthin — Strophanthin. Origin. — A glucosid obtained 
from the seeds of several species of Strophanthus, chiefly from Strophanthus hispidus. 

Description and Properties. — A white, amorphous or ciystalhne powder, of an acid- 
ulous, intensely bitter taste ; soluble in water and in alcohol. 

Dose. — Y^o' ^° ¥0 g^'^ii'^ (0.0006-o.coi Gm.). 

Ouabain — Ouabain — Ouabain. — Origin. — A glucosid obtained from Acocan- 
thera ouabalo and Strophanthus glabrus. 

Description and Properties. — A white, transparent, cr}^stalline powder, inodorous 
and of a slightly bitter taste. Soluble in hot water, sparingly soluble in cold water, 
insoluble in alcohol. 

■i-o grain (0.000032-0.00012 Gm.). 



Antagonists and Incompatibles. — Probably the same as for 
digitalis. 

S3merg"ists. — Digitalis, spartein, adonidin, etc. 

Physiological Action. — Externally and Locally. — The tincture 
of strophanthus has no local action of importance. Strophanthin 
and ouabain, however, possess marked sedative properties, the 
latter being much the stronger. They paralyze the ends of the 
sensory nerves and are powerful local anesthetics, in this respect 
surpassing even cocaine in their influence upon the cornea, the 
anesthesia produced by the glucosids being of much longer dura- 
tion than that caused by cocaine. 

^Yhen poisonous amounts of ouabain are applied locally the motor nerves are 
paralyzed. 

These substances apparently have no action upon the central 
nervous system. 

Externally. — Digestive System. — Strophanthus is similar in its 
action to digitalis, though less apt to disturb digestion in small 
doses ; on the contrary, its bitter taste tends to improve the 
appetite. 

Ouabain increases peristalsis and acts as an emetic by centric influence. 

Circulatory System. — Upon the heart its action is identical with 



550 A TEXT-BOOK OF MATERIA MEDIC A. 

that of digitalis, though differing from the latter drug in its effect 
upon arterial tension and the arterioles. Strophanthus does not 
contract the arterioles and the arterial pressure is but slightly 
raised, the elevation being due to the increased force of the heart, 
toxic doses paralyzing it in systole. 

The glucosidal principle, ouabain, on the other hand, increases arterial tension 
and contracts the principal vessels in the same manner as digitalis. 

Nervous System. — Strophanthus affects the nervous system 
even less than digitalis. Poisonous doses, while not influencing 
the motor nerves so much as digitalis, act as a direct muscle- 
poison. 

Ouabain paralyzes both the sensory and motor nerves and abolishes reflex action, 
being a direct poison to the striated muscles. 

Respiratory System. — It has no important action. 

Ouabain primarily increases and secondarily diminishes respiration through its action 
upon the center. 

Absorption and Elimination. — Strophanthus is rapidly absorbed, 
and more readily eliminated than digitaHs, possessing no cumulative 
action. It is principally excreted by the kidneys, increasing the 
amount of urine by the strengthened heart's action. Unlike digi- 
talis, the drug has no influence upon the caliber of the renal 
vessels. 

Teinperatnre. — Very large doses of strophanthus cause a slight 
reduction of temperature, not, however, to the extent of digitalis. 

Eye. — Excessive doses contract the pupil and increase intra- 
ocular tension. 

Uterus. — It resembles digitalis, though more feeble in its action 
upon the uterus. 

The symptoms and treatment of Poisoning are similar to those 
described under Digitalis, although strophanthus is more apt to 
occasion diarrhea. 

Therapeutics. — Externally and Locally. — Strophanthin has 
been occasionally employed as a local anesthetic, but the testimony 
in its favor is hardly sufficient to encourage its use 

Internally. — Strophanthus is a cardiac remedy, being indicated 
in the same varieties of heart disease as digitalis. It is of particular 
value in stenosis of the mitral orifice, having a happy influence in 
controlling the irregular rhythm, nervous dyspnea, and intermittent 
pains distinctive of this lesion. The drug is also well adapted in 



CARDIAC STIMULANTS. 551 

subduing functional irregularities of rhythm in cases of irritable or 
tobacco heart. 

Theoretically, strophanthus is superior to digitalis in certain 
stages of Bright' s disease and heart failure of elderly people with 
slightly degenerated arteries. 

Shoemaker advocates the use of strophanthus in the treatment 
of psoriasis, combining it with the fluid extract of hoang-nan. 

While in the majority of cardiac diseases digitaHs should be 
first tried, w^here it fails strophanthus is the proper recourse. It is 
a peculiarly efficient drug in the cardiac diseases of cJiildren, accord- 
ing to the majority of observers being safer than digitalis for young 
patients. 

Strophanthin has been used hypodermically with some success 
for the relief of chills due to malaria, shock, or nervousness. 

Dr. Gemmell and other observers claim that ouabain in doses of from yo^q to -^\-^ 
grain (0.00006-0.00003 Grn.) greatly reduces the number and severity of the paroxysms 
in whooping cough. 

Contraindications. — The same as for digitalis. 

Administration. — Of the preparations of strophanthus, the 
tincture is preferable, both for convenience and safety. Should 
strophanthin or ouabain be desirable, a solution is to be pre- 
ferred. 

Scoparius— Scoparii— Scoparius. V. S. JP. 

(Broom.) 

Origin. — The tops of Cytisus scoparius L., a shrub 3 to 6 feet 
(.9-1.8 M.) high, found in Western Siberia and the greater part of 
Europe. It is sometimes cultivated, and is occasionally met with 
wild in some of the Middle and Southern States. 

Description and Properties. — Occurring in thin, flexible, 
branched twigs, pentangular, winged, dark green, nearly smooth, 
tough, usually free from leaves ; odor pecuHar when bruised ; taste 
disagreeably bitter. 

The constituents of scoparius are an oily, bitter substance, jr/^^r- 
teine, a cardiac stimulant, and a neutral, crystalline principle, scopa- 
rin, to which the diuretic action of the drug is due. 

Dose. — ^i drachm (2.0-4.0 Cc), in infusion. 

Official Preparations. 

Extractum Scoparii Fluidum — ExtrScti Scoparii Fluidi— Fluid Extract of 
Scoparius. — Dose, ^-i fluidrachm (2.0-4.0 Cc). 



552 A TEXT-BOOK OF MATERIA MEDICA. 

Sparteinse Siilphas — Sparteinae Sulphatis — Sparteine Sulphate. — The neu- 
tral sulphate obtained from the alkaloid sparteine. 

Description and Properties. — Colorless, white, prismatic crystals, or a granular 
powder, odorless, and having a slightly saline and somewhat bitter taste; liable to 
attract moisture when exposed to damp air; very soluble in water and alcohol. 

Dose. — -^Q-2 grains (0.003-0.1 Gm.j. 

Unofficial Prepaj'ation. 

Scoparine — Scoparine — Scoparine. — Description and Properties. — Amorphous 
or in small crystals, of a pale-yellow color, inodorous and tasteless. 
Dose. — 1-15 grains (0.06-1.0 Gm.), as a diuretic. 



Antag-onists and Incompatibles. — The antagonists are the 
same as for digitahs, and tannic acid and potassium iodide are 
incompatibles. 

Synergists. — Digitahs, strophanthus, adonidin, etc. 

Physiological Action. — Externally and Locally, — No action 
observed. 

Internally. — Digestive System. — Sparteine sulphate acts like bit- 
ters in improving the appetite and digestion. Large doses, as with 
digitalis, produce vomiting and purging. 

Circulatory System. — It has been claimed that the action of 
sparteine upon the heart and blood-vessels is similar to that of 
digitalis ; but numerous experiments upon animals show that the 
drug has no action upon these organs. (Gushing and Matthews, 
Archives of Experimental Pharmacology and Pathology, 1895.) 
Notwithstanding the results of the pharmacological experiments 
above referred to, the author has observed that, clinically, the drug 
is similar in its action to that of digitalis, save that it is not so 
powerful, but more rapid, though the arterioles are not contracted 
as is the case with digitalis. 

Nervous System. — Sparteine resembles coniine rather than digi- 
tahs in its action upon the nervous system, depressing the brain 
and spinal cord, and lowering reflex action through paralysis of 
the motor tracts. Under toxic doses there is also extreme mus- 
cular weakness, often complete paralysis. 

Respiratory System. — Medicinal doses produce no effect. Toxic 
doses slow and weaken the respiration, death being possible from 
paralysis of the respiratory center. 

Absorption and Elimination. — It is rapidly absorbed and as read- 
ily eliminated, and, unlike digitalis, has no cumulative action. 
In disease it is an active diuretic, particularly the infusion or fluid 



CARDIAC STIMULANTS. 553 

extract or the alkaloid scoparin. Sparteine, on the other hand, is 
not an active diuretic. 

Scoparius therefore increases the flow of urine and the excre- 
tion of urea, The drug has no direct action upon the renal struc- 
ture, diuresis being produced by increased blood-pressure. It also 
possesses diaphoretic properties. 

Poisoning. — The following symptoms occur : Small, rapid, and 
irregular pulse, dyspnea, great muscular weakness, incoordination 
of movement, and muscular tremors, followed possibly by clonic 
and tonic convulsions, which are replaced by marked depression 
of the nervous and muscular systems, and collapse, death usually 
resulting from paralysis of the respiratory^ center. 

Treatment of Poisoning. — The respiration should be stimulated 
by hypodermic injections of strychnine and atropine. It may even 
be necessary to apply electricity over the vagi or practise artificial 
respiration. Potassium iodide or solutions of tannic acid should 
be given, and the free use of diuretics or diluents to favor elim- 
ination. 

Therapeutics. — Externally and Locally.-^— ^o influence is ex- 
erted. 

Internally. — Scoparius is used for the same purposes as digi- 
talis. It is particularly serviceable in some cases of nephritis with 
weak, irregular heart-action, and in chronic Bright' s disease with 
cardiac hypertrophy and high arterial tension. It is also useful in 
the nervous, irregular heart of opium habitues. 

Sparteine sulphate has been recommended in paralysis agi- 
tans and asthma. Like strophanthus, it is of more value in mitral 
than in other valvular diseases. 

For some reason scoparius is generally less esteemed than 
digitalis, although, while competent clinicians consider it of minor 
importance as a cardiac remedy, the drug is not without enthusi- 
astic advocates among those of authority. 

Contraindications. — Practically the same as for digitaHs, though 
less definite. 

Administration. — The fluid extract of scoparius may be given, 
or the decoction, "made by adding \ an ounce (16.0 Gm.) of the 
broom-tops to i pint (J liter) of water and boiling them down to 
\ pint (250 Cc). Of this i ounce (32.0 Cc.) should be taken 
every three hours. This decoction is one of the most efficient 
diuretics in cardiac dropsy " (Hare). 

The sparteine sulphate is usually employed when an action on 



554 ^ TEXT-BOOK OF MA TERIA MEDICA. 

the heart is desired : it may be administered either hypodermically, 
in pill, capsule, or aqueous solution. 

Cactus— Cacti— Cactus. 

(Night-blooming Cereus.) 

Origin. — The stems and flowers of Cactus grandifloriis L.,. 
a plant indigenous in tropical America and frequently cultivated 
for ornament. 

Preparations. 

Extractum CScti Fluidum— Extract! Cacti Fluidi— Fluid Extract of Cac- 
tus. — Dose, 5-10 minims (0.3-0.6 Cc). 

Tinctura CScti — Tincturae CScti — Tincture of Cactus. — Dose, 15-20 minims 
(1.-1.2 Cc), 

Physiolog-ical Action and Therapeutics. — Cactus differs from 
digitalis in its less disturbing influence upon the digestive appa- 
ratus. 

Its action upon the circulation is to elevate arterial pressure and 
increase the strength and rapidity of the heart's action when given 
in medicinal doses. Toxic doses, on the contrary, diminish both 
the blood-pressure and the pulse-rate, rendering the heart irregular 
in its action and arresting it in systole. Moreover, the reflexes are 
increased by poisonous doses, death being preceded by clonic and 
tetanic convulsions of spinal origin. 

Therapeutically, cactus probably possesses no advantages over 
digitalis. It has, however, been highly recommended by certain 
physicians in myocarditis, aortic regurgitation, functional disorders 
of the heart, severe arrhythmia, angina pectoris, and cardiac weak- 
ness following typhoid fever. 

Dr. Wilcox considers mitral stenosis a contraindication to its 
use. It is asserted that it produces no cumulative effects or 
untoward symptoms. 

Adonis Vernalis— Adonidis Vernalis— False Helle- 
bore. 

(Pheasant's Eye.) 

Origin. — A perennial herb attaining a height of about lo inches 
(25 Cm.), indigenous in Europe. 

Description and Properties. — It has but little odor and a some- 
what acrid and bitter taste. The plant contains a glucosid, adoni- 



CARDIAC STIMULANTS. 555 

din, to which it owes its medicinal properties. This constituent is 
a light-colored, crystalline powder, of a bitter taste and soluble in 
water and alcohol. 

Dose of Adonidin. — ^-\ grain (0.003-0.01 Gm.). 

Antagonists, Incompatibles, and Synergists. — The same as 
for digitahs. 

Physiological Action and Therapeutics. — The action of adoni- 
din is similar to that of digitalis, although more nearly resembling 
that of digitalin, save that it is not cumulative. 

It is used for the same purposes as digitalis, being peculiarly 
valuable in relieving the pains of heart disease, and is by some 
physicians preferred to digitalis in the treatment of aortic and mitral 
insufficiency, cardiac asthma, 'd.xidi functional ir re gidarity of the heart. 

Convallaria— Convallariae— Convallaria. 17. 8, T. 

(Lii.Y OF THE Valley.) 

Origin. — The rhizome and roots of Co7zvallaria majalis L., a 
sternless perennial indigenous in Europe, Northern Asia, and North 
America. 

Description and Properties. — Of horizontal growth and some- 
what branched, about \ inch (3 Mm.) thick, cylindrical, wrinkled, 
whitish, marked with a few circular scars; at the annulate joint 
with about eight or ten thin roots ; fracture somewhat fibrous, 
white ; odor peculiar, pleasant ; taste sweetish, bitter, and somewhat 
acrid. 

Convallaria contains two glucosids : convallamarin, the cardiac- 
acting principle ; and convallarin, an emeto-cathartic principle. 

Official Preparations. 

ExtrSctum Convallariae Fluidum — Extr^cti Convallariae Fluidi — Fluid Ex- 
tract of Convallaria. — Dose, 15-30 minims (1-2 Cc). 

Unofficial Preparations. 
Extractum Convallariae— Extr^cti Convallariae— Extract of Convallaria. — 

Dose, 5-15 grains (0.3-1.0 Cc). 

Infiisum Convallariae — Infiisi Convallariae — Infusion of Convallaria. — Dose, 
\-2 ounces (15-60 Cc.) (25 parts in 75 parts of water). 

Convallamarinum — Convallamarlni — Convallamarin. — Description and 
Properties. — A whitish-brown, amorphous powder, soluble in water and alcohol. 

Dose. — i-2 grains (0.016-0. 12 Gm.). 

Convallarinum — Convallarini — Convallarin. — Description and Properties. — A 
crystalline body insoluble in water, soluble in alcohol. 

Dose. — 2-4 grains (o. 1 2-0.24 Gm.). 



556 A TEXT-BOOK OF MA TERIA MEDICA. 

Antagonists and Incompatibles. — The antagonists are the 
same as for digitahs ; tannic acid precipitates the convallamarin. 

Synerg-ists. — The cardiac stimulants enhance its cardiac action ; 
emetics and cathartics aid its emeto-cathartic effects. 

Physiological Action. — Almost identical with that of digitalis, 
but less powerful and possessing no cumulative action. Prepara- 
tions free from convallarin do not disturb the stomach nor affect 
the cerebro-spinal functions. It is asserted that convallaria has 
stronger diuretic properties than digitalis. 

Convallamarin in some cases has produced, among other un- 
toward symptoms, hemoptysis and dyspnea. 

Convallarin is a drastic purgative, and in full doses occasions 
nausea and gastric pain. 

Therapeutics. — Convallaria is used for the same purposes ex- 
actly as digitalis. The only advantage it possesses over the latter 
drug is that it has no cumulative action. By some physicians it is 
considered superior to digitalis as a diuretic and cardiac stimulant 
after failure of compensation, the diuresis it occasions persisting for 
some time after the withdrawal of the drug. 

It has been employed with some benefit in various forms of 
neuralgia, and has even been recommended to calm the restlessness 
and relieve the insomnia of fever. 

Contraindications. — The same as for digitalis. 

Administration. — The fluid extract is the best preparation to 
use, although the infusion is highly recommended by many physi- 
cians. 

Caffeina—Caffeinae— Caffeine. TJ. S. P. 

Origin. — A feebly basic, proximate principle obtained from the 
dried leaves of Thea Sinensis (tea) L., or from the dried seeds of 
Coffea Arabica (coffee) L., and found also in other plants. 

It may also be prepared synthetically from theobromine by the 
introduction of a third methyl group. 

Description and Properties. — Fleecy masses of long, flexible, 
white crystals, having a silky luster, without odor and of a bitter 
taste ; permanent in the air ; soluble in 80 parts of water and 
33 parts of alcohol. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Official Preparations. 

Caffeina Citrata — Caffeinae Citratae — Caffeine Citrate. — Description and 
Properties. — A white powder, odorless, having a purely acid taste and an acid 



I 



CARDIAC STIMULANTS. 557 

reaction. I part of citrated caffeine forms a clear, syrupy solution with about 3 parts 
of water. 

Dose. — 2-5 grains (0.12-0.3 Gm.). 

Caffeina Citrata EffervSscens — Caffeinse Citratae EffervescSntis — Efferves- 
cent Citrated Caffeine. — Dose, 1-4 drachms (4.0-16.0 Gm.). 

Allied Coinpoiinds. 

Guaranine. — The alkaloid obtained from the seeds of Paullinia cupana. 

Theine. — An alkaloid obtained from tea. 

Theobromine. — An alkaloid obtained from cacao seeds. 

Sodio-theobromine Salicylate (Diuretin). — An active diuretic described under 
the group " Diuretics." 

Guaranine, theine, and theobromine, while chemically almost identical with caffe- 
ine, differ from it somewhat in their physiological action. 

Guaranine depresses first the sensory and afterward the motor nerves, affecting 
them from the center toward the periphery. Its primary effect in toxic doses is to pro- 
duce general hyperesthesia, succeeded by convulsions of spinal origin. 

Theine in its action veiy closely resembles guaranine, save that when injected it 
causes local anesthesia. It lowers the temperature, while caffeine tends to raise bodily 
heat. 

Theobromine differs in no essential from caffeine. 

Antagonists and Incompatibles. — Cerebral and cardiac de- 
pressants antagonize the action of caffeine. 

Synergists. — Members of this group and the Cerebral and 
Motor Excitants. The action of caffeine upon the digestive tract 
may be enhanced by the vegetable bitters. 

Physiological Action. — Externally and Locally. — Caffeine pos- 
sesses no very important local action, though freshly roasted coffee 
is slightly analgesic and deodorant, as well as antiseptic — a prop- 
erty due to the empyreumatic oils developed by roasting rather 
than to the caffeine which it contains. 

Internally. — Digestive System. — In moderate amounts caffeine, 
like tea and coffee, stimulates the appetite, improving the digestion, 
and relieving the sense of plenitude in the stomach. All of them 
increase peristalsis and (particularly coffee) act as mild laxatives 
and slightly stimulate the secretion of bile. 

, Immoderate and continued dosage of caffeine or the excessive 
use of tea and coffee profoundly disturbs the digestive function, 
resulting in gastric catarrh, indigestion, hepatic congestion, consti- 
pation, and hemorrhoids. 

Circidatory System. — Medicinal doses of caffeine strengthen and 
quicken the heart's action. The rapidity of the heart's action is 
increased, shortening the diastolic period, the drug in this respect 
differing from digitalis ; at the same time the arterial pressure is 
elevated. 



558 A TEXT-BOOK OF MATERIA MEDIC A. 

The precise modus operandi of caffeine in its action upon the 
circulatory system is still a disputed question, some investigators 
claiming that its whole and only influence proceeds from a direct 
stimulation of the heart-muscle, while others consider its action to 
be upon the nervous system. So far as relates to arterial pressure, 
the preponderance of testimony seems to prove that the tension 
is raised independently of any action on the vaso-motor centers. 
Excessive doses depress the heart, causing an irregular, slow, and 
weak pulse. 

Nervous System. — The drug is a decided cerebral excitant, stim- 
ulating the mental function, occasioning wakefulness, and under 
large doses producing hallucinations and delirium. 

There is a marked difference between the effects upon the brain 
caused by caffeine and those occasioned by opium. The former 
renders the reasoning and imaginative powers more acute, enabling 
the person to perform increased and prolonged mental work. 
Moreover, the cerebral excitation caused by caffeine is not suc- 
ceeded by mental depression and sleep ; while opium occasions 
an incoordination of mental activity, the brain being incapable of 
performing active practical and physiological work, and the reason- 
ing powers rendered subservient to the imaginative. The opium 
habitue thus becomes a visionary, his mental powers inclining more 
to revery than to action. The primary excitation induced by the 
drug, however, is soon succeeded by lethargy and sleep. 

The moderate use of tea or coffee increases muscular endu- 
rance ; large doses, on the other hand, occasion muscular trem- 
bling and marked weakness. Excessive doses lessen the activity 
of the spinal reflex centers. In moderate amounts coffee possesses 
some aphrodisiac action. 

Respiratory System. — Medicinal doses slightly stimulate, while 
toxic doses depress, the respiration. 

Absorption and Elimination. — Caffeine is freely absorbed, and is 
chiefly eliminated by the kidneys, a portion being oxidized in the 
body. The primary effect of the drug upon the kidneys is to 
diminish the blood-supply to the kidneys, thereby lessening the 
amount of urine. At the same time the drug has a direct stimu- 
lating action upon the secreting structure of the kidney, and if its 
effect upon the vaso-motor center is not too marked its general 
action is that of a diuretic. 

Ordinarily, caffeine lessens tissue-waste; the elimination of urea, 



CARDIAC STIMULANTS. 559 

however, is not uniform, being in some cases increased and in others 
diminished. 

Temperature. — Under large doses of the drug the temperature 
is slightly elevated, the result of combined increase of heat-pro- 
duction and heat-dissipation. Toxic doses first raise and then 
depress temperature. 

Eye. — Strong solutions of caffeine applied to the cornea act as 
a mild mydriatic and anesthetic. Hutchinson records a case of 
amblyopia produced by the drug. 

Untoward Action. — Caffeine occasionally causes marked cere- 
bral congestion, insomnia, and embarrassment of respiration, while 
the untoward effects of an immoderate use of coffee are described 
by Guilliot {Nat. Disp.^ p. 363) as follows : 

'' The skin is pale or dusky, the expression is dull, and the 
features have the look of premature old age, and sometimes are 
slightly swollen. The flesh wastes, the eyes have a glassy look, 
the pupils are dilated, the lips and tongue are tremulous ; the 
appetite is lost ; there is insomnia or else disturbed sleep ; dyspep- 
sia accompanies constipation or diarrhea ; neuralgia affects the 
stomach and other parts ; headache and vertigo are common, and 
spasms or general convulsions may occur." According to the 
same writer, " habitual excess of coffee induces in men sexual 
apathy and impotence, and in women leucorrhea. Sometimes it 
produces pruritus ani aut vulva;." 

Poisonijtg. — A case has been reported by Liell where 18 grains 
(1.16 Gm.) of citrated caffeine taken by a woman were in an hour 
and a half accompanied by the following symptoms : 

" Delirium, semi-consciousness, absence of headache, pulse 55 
and irregular, cold extremities and general clammy perspiration, 
normal temperature (?), anesthesia, slight paresis of hands, feet, 
and tongue, and a reeling gait. Convulsions followed of a teta- 
noid character ; the pupils were normal, the vision dim ; some 
vomiting took place ; there was abdominal colic, but no opening 
of the bowels ; and urination was frequent and copious." 

Treatment of Poisoniftg. — This should include the use of emetics 
and eliminants, together with diffusible stimulants and the appHca- 
tion of external heat. 

Therapeutics. — Externally a7id Locally. — Burning coffee in a 
room deodorizes the air, and micro-organisms can be destroyed by 
allowing a bowl of coffee to stand in it. Powdered coffee is used 
to disguise the offensive odor of iodoform, and is frequently asso- 



560 A TEXT-BOOK OF MATERIA MEDICA. 

ciated with it in the form of an ointment in the treatment of aural 
eczema. Equal portions of pulverized coffee and boric acid have 
been recommended by Guerder as an insufflation in whooping 
cough. 

Internally. — The chief value of caffeine is as a diuretic and 
cardiac stimulant, being peculiarly useful in cases of senile cardi- 
opathies associated with nephritis, in which, from degeneration of 
the heart-muscle, digitalis is not well tolerated. 

In some instances the primary effect of caffeine is to increase 
the pulse-rate ; usually, however, if the remedy be adapted to the 
case, there is a secondary slowing of the heart's action. The drug 
is considered by some physicians to be superior to digitalis as a 
cardiac stimulant in valvular disease accompanied by fatty heart. 
It is an efficient remedy to counteract the cardiac depression in low 
fevers, and is a comparatively safe drug in myocarditis. 

It is a remarkably efficacious remedy in cardiac and renal 
dropsy and to remove pleuritic effusion, etc. 

Its action upon the digestive system renders caffeine of great 
value as a stomachic tonic. Migraine, due either to gastric catarrh 
or nervousness, frequently yields to this drug. 

Its value in the treatment of headaches may be enhanced by 
administering it together with antipyrine or sodium bromide. 

Choleraic diarrhea, the result of nervous depression, is often 
markedly benefited by citrated caffeine. It has also been used 
with some success in the diarrhea of phthisis. 

The pains of locomotor ataxia have been greatly relieved by 
the hypodermic injection of from -g- to ^ grain (0.01-0.03 Gm.) 

of THEINE. 

SoDio-BENzoATE OF CAFFEINE in doscs of 5 to 10 grains (0.32- 
0.64 Gm.) is considered by Misrachi to be superior to ergot in 
post-partum hemorrhage. Caffeine possesses a considerable repu- 
tation as a remedy for asthma. 

It is a matter of frequent observation that strong coffee cer- 
tainly modifies the effects of alcoholic intoxication. Hiccough is 
often relieved by coffee. 

Caffeine or strong coffee has unquestionably proved valuable 
in the reduction of strangidatcd hernias after taxis has failed. 

The medical uses of caffeine would be incomplete without 
mention of its extreme value in opium-poisoning. Here a salt of 
caffeine may be used hypodermically or a strong infusion of coffee 
given by the mouth or rectum. 



CARDIAC STIMULANTS. 561 

In conclusion, it may not be out of place, in comparing this 
drug with digitalis, to quote again from the National Dispensatory, 
5th ed., p. 365 : " Unlike digitalis, which affects only certain invol- 
untary muscles, caffeine, like alcohol, stimulates the entire muscu- 
lar and vascular systems. It has been repeatedly said that caffeine 
and digitalis cannot be therapeutically substituted for one another 
— that the former acts where the latter ceases to act ; and the ex- 
planation of this fact resides in their very dissimilar modes of 
action. When digitalis fails, it is because the heart is either posi- 
tively or relatively incompetent to propel the blood, and the medi- 
cine has no power of strengthening except by tonically contracting 
it ; but coffee or caffeine stimulates the nervous centers which are 
the source of the heart's power, and temporarily restores the regu- 
larity and efficiency of its function, and so permits the removal of 
the dropsies, etc. which immediately threaten the extinction of life." 

Contraindications. — Ordinarily, caffeine is contraindicated in 
acute inflammations, particularly of the kidneys. 

Administration. — The alkaloid may be given by the stomach, 
but when hypodermic medication is desired caffeine is unavailable, 
a fresh salt for hypodermic use being properly employed, made by 
combining caffeine with salicylic acid, cinnamic acid, or sodium 
benzoate. The latter salt — sodio-benzoate of caffeine — is probably 
the most eligible and contains 45 per cent, of caffeine. 

The citrated caffeine should be given in pills, capsules, or 
tablets ; the effervescent citrate, in water. 

A valerianate of caffeine is prepared which has been employed 
with success, it is asserted, in Jiysterical vomiting and wJiooping 
cough in doses of from J to 2 grains (0.03-0.12 Gm.). 

Strong coffee serves as a most excellent substitute for the alka- 
loid, and may be given by the mouth or as an enema. 

Alcohol— Alcoholis— Alcohol. JJ. S. P. 

Origin. — A liquid composed of about 91 per cent, by weight or 
94 per cent, by volume of Ethyl Alcohol, and about 9 per cent, by 
weight of Water. 

Description and Properties. — A transparent, colorless, mobile, 
and volatile liquid, of a characteristic, rather agreeable odor, and a 
burning taste. Miscible with water, ether, or chloroform in all pro- 
portions. It is inflammable, and readily volatihzed even at low 
temperatures. Alcohol should be kept in well-closed vessels, in a 
cool place, remote from Hghts or fire. 

36 



562 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

Alcohol Dilutum — Alcoholis Diluti — Diluted Alcohol. — A liquid composed 
of about 41 per cent, by weight, or about 48.6 per cent, by volume, of absolute Ethyl 
Alcohol, and about 59 per cent, by weight of Water. It should be kept in well-closed 
vessels, in a cool place, remote from lights or fire. 

Alcohol Absolutum— Alcohaiis Absolut!— Absolute 
Alcohol. Tl.S.r. 

Orig-in. — Ethyl Alcohol, containing not more than i per cent. 
by weight of Water. 

Description and Properties. — A transparent, colorless, mobile, 
and volatile liquid, of a characteristic, rather agreeable odor, and a 
burning taste. Very hygroscopic. It should be kept in well- 
stoppered bottles or tin cans, in a cool place, remote from lights or 
fire. 



Alcohol Deodoratum— Alcoholis Deodorati— De- 
odorized Alcohol. TJ, S. J*. 

Origin. — A liquid composed of about 92.5 per cent, by weight, 
or 95.1 per cent, by volume, of Ethyl Alcohol, and about 7.5 per 
cent, by weight of Water. 

Description and Properties. — As given and described under 
Absolute Alcohol. 

Spiritus VIni Gallici—SpTritus VTni Gallici— Brandy. 

77. S. I". 

Origin. — An alcoholic liquid obtained by the distillation of the 
fermented, unmodified juice of fresh grapes, and at least four years 
old. 

Description and Properties. — A pale amber-colored liquid, 
having a distinctive odor and taste and a slightly acid reaction. Its 
specific gravity should not be more than 0.941, nor less than 0.925, 
corresponding, approximately, to an alcoholic strength of 39 to 47 
per cent, by weight or 46 to 55 per cent, by volume. 

Spiritus Frumenti— Spiritus Frumenti— Whiskey. 

U. S. P. 

Origin. — An alcoholic liquid obtained by the distillation of the 
mash of fermented grain — usually mixtures of Corn, Wheat, and 
Rye — and at least two years old. 



1 



CARDIAC STIMULANTS. 563 

Description and Properties. — An amber-colored liquid, having 
a distinctive odor and taste, and a slightly acid reaction. Its 
specific gravity should not be more than 0.930 nor less than 0.9 1 7, 
corresponding, approximately, to an alcoholic strength of 44 to 50 
per cent, by weight or 50 to 58 per cent, by volume. 

VTnum Album— VIni Albi— White Wine. 77. H, J>. 

Origin. — An alcoholic Hquid made by fermenting the juice of 
fresh grapes, the fruit of Vitis vinifera (nat. ord. Vitacece), freed from 
seeds, stems, and skins. 

Description and Properties. — A pale amber-colored or straw- 
colored liquid, having a pleasant odor, free from yeastiness, and a 
fruity, agreeable, slightly spirituous taste, without excessive sweet- 
ness or acidity. It should contain not less than 10 nor more than 
14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by 
volume — of absolute alcohol. 

Vinum Rubrum— VIni Rubri~Red Wine. U.S.I*. 

Origin. — An alcoholic liquid made by fermenting the juice of 
fresh, colored grapes, together with their skins. 

Description and Properties. — A deep red liquid, having a 
pleasant odor, free from yeastiness, and a fruity, moderately astrin- 
gent, pleasant, and slightly acidulous taste, without excessive sweet- 
ness or acidity. It should contain not less than 10 nor more than 
14 per cent, by weight — equivalent to 12.4 to 17.3 per cent, by 
volume — of absolute alcohol. 

Unofficial Alcoholic Preparatio7is. 

Spiritus Rectificatus — Spiritus Rectificati — Rectified Spirit contains 85 per 
cent, by weight of absolute alcohol. 

Proof Spirit contains 49 per cent, by weight of absolute alcohol, together with a 
peculiar volatile oil and other foreign material. 

Gin is usually distilled in Holland from rye or barley, and flavored with juniper ber- 
ries and hops. It contains about 42 per cent, by weight of absolute alcohol, and is 
probably more diuretic than other hquors because of the oil of juniper it contains. 

Rum is obtained by distilling fermented molasses, having about the same alcoholic 
strength as gin. 

Port Wine is prepared by adding spirit during the process of manufacture, bring- 
ing the alcoholic strength up to 30 or 40 per cent. 

Sherry Wine is a dry wine, having from 20 to 35 per cent, of alcohol. 

Sparkling Wines contain from 8 to lo per cent, of alcohol. They are more or 
less sweet wines, and are charged with carbonic acid, being bottled before fermentation 
is completed, the grape-sugar, in consequence, not undergoing conversion into alcohol, 
The sparkling wines are Champagne, Hock, and Sparkling Catawba. 



564 ^ TEXT-BOOK OF MATERIA MEDIC A. 

Sweet Wines are those in which the sugar has not all been converted into alcohol, 
the alcoholic strength being therefore relatively \o\^ — from 6 to 7 per cent. Among the 
sw^eet wines may be classed Angelica, Madeira, Malaga, Muscatel, Tokay, etc. 

Dry Acid Wines are tliose in which the fermentation is complete, the alcoholic 
strength varying from 5 to 7 per cent. They are such as California Hock, Ohio and 
Kelly Island Catawba, Rhine and Moselle wines, Hochheimer, Diirkheimer, Deides- 
heimer, etc. 

Light Red Wines contain 5 to 7 per cent, of alcohol, and are astringent, contain- 
ing tannic acid and the coloring matter of the grape. They are Claret, Red Rhine, 
Concord, Hungarian, etc. 

Beer, Ale, and Porter are prepared by fermenting malted grain with hops and 
adding other bitters. Beer contains from 2 to 3 per cent, of alcohol ; ale and porter, 
from 4 to 6 per cent., besides carbonic and lactic acids, malt extract, various aromatics, 
and potassium and sodium salts. 



Antagonists and Incompatibles. — The motor, cerebral, and 
cardiac depressants are antagonistic to moderate amounts of alcohol. 

Synergists. — The motor excitants, atropine, ether, and the dif- 
fusible stimulants. 

Physiological Action. — Few drugs have occasioned such di- 
versity of opinion regarding their physiological action and uses as 
alcohol. With those who — as Nathaniel asked, " Can any good 
thing come out of Nazareth ?" — question whether any benefit can 
accrue from alcohol, being honestly convinced that the drug pos- 
sesses no value in medicine, the author begs leave to take respect- 
ful yet decided issue. Indeed, extensive reading, experimentation, 
and clinical experience have alike proved to him conclusively that 
we have in alcohol a drug endued with peculiar and invaluable 
properties, rendering its efficacy inferior to that of no remedy in the 
range of materia medica. Like opium and other powerful agents, 
the drug may prove noxious or beneficial according to the manner 
and judgment with which it is employed. 

The physiological action as here given agrees with the best 
authorities on the subject. 

Externally and Locally. — Alcohol is a powerful antiseptic and 
disinfectant. It possesses also rubefacient, astringent, and anhi- 
drotic properties. When appHed in full strength to the skin it pro- 
duces a sensation of coldness, due to rapid evaporation. Should 
the drug be diluted, the sensation of cold is greatly diminished. 
If evaporation be prevented, the effect is that of heat or burning, 
owing to the penetration of the drug through the epidermis and its 
chemical influence upon the tissues beneath. 

Its effect upon mucous membranes is similar to that upon the 



CARDIAC STIMULANTS. S^5 

skin, save that the former are more readily affected. The mucous 
membrane becomes whitened and corrugated, because of the coagu- 
lation of albumin and the abstraction of water. The white film, 
which is the precipitated albumin, later disappears as the albu- 
min is redissolved in Hquids present, although the prolonged action 
of alcohol upon mucous membranes produces a permanent co- 
agulation. 

When the drug is applied to the skin the secretion of sweat is 
lessened and the cutaneous blood-vessels contracted. 

Internally. — Digestive System. — The local action upon the mu- 
cous membrane of the mouth is as above described. There is a 
burning sensation, and marked increase of saliva due entirely to 
reflex action. When ingested a sense of warmth is experienced in 
the stomach, the blood-vessels of which are dilated, with accom- 
panying increase in the secretion of gastric juice, as well as stimu- 
lation of peristaltic action. As a consequence, moderate amounts 
of the drug, when taken before meals, improve the appetite and 
favor digestion : if taken during the active period of digestion, the 
process is retarded. 

It will be observed that the action of alcohol upon the digestive 
system is quite similar to that of vegetable bitters, immoderate 
amounts checking the flow of gastric juice and increasing the secre- 
tion of mucus, producing a catarrhal condition ; while excessive 
doses or the daily and intemperate use of the drug frequently 
occasions nausea and vomiting. 

Upon the intestines alcohol acts as an astringent, brandy being 
an efficient agent in checking diarrhea. Small amounts of the 
drug act as an hepatic stimulant, while large quantities change the 
character of the bile, at the same time lessening its amount. 

Circulatory System. — Taken into the stomach, alcohol reflexly 
and rapidly stimulates the heart before absorption can take place, 
the effect upon the circulation persisting after the drug is absorbed. 
Cardiac action is rendered more rapid and forcible, probably by 
stimulation of the heart-muscle, as well as of the accelerator 
center in the medulla. Arterial tension is raised, although the 
blood-vessels are dilated, especially those of the skin, owing 
to the depression of the vaso-motor center located in the ves- 
sel-walls. Toxic doses depress the heart and still further dilate 
the arterioles, greatly lowering the blood-pressure. This action 
of alcohol, in causing the heart to beat stronger and faster, at 
the same time dilating the blood-vessels — particularly those of 



566 A TEXT-BOOK OF MATERIA MEDICA. 

the peripheries — renders the drug one of the most valuable dif- 
fusible stimulants. 

Excessive doses of alcohol greatly depress or paralyze the 
heart, while an enormous amount, when taken upon an empty 
stomach, by reflex action occasioning cardiac paralysis, may pro- 
duce instantaneous collapse. 

The ameboid movements of the white blood-corpuscles are tem- 
porarily increased, though subsequently diminished. The function 
of the red corpuscles is impaired, preventing the oxyhemoglobin 
from parting with its oxygen, consequently retarding oxidation in 
the tissues. It is a matter of observation that persons addicted to 
the habitual use of alcohol are frequently obese, on account of the 
imperfect combustion of fat and its consequent accumulation in the 
tissues. 

Experiments have conclusively shown that moderate amounts 
of alcohol are oxidized during their circulation in the body. Alco- 
hol must, then, serve as a food to a certain extent. Indeed, experi- 
ments have irrefutably proved that the body-weight of an animal 
may be maintained for a considerable period upon alcohol alone. 
This pecuhar and apparently paradoxical property, of lessening 
and at the same time undergoing oxidation, renders the drug of 
eminent value in certain conditions. 

Nervous System. — Moderate amounts of alcohol stimulate the 
nervous system, particularly the brain, chiefly through the increased 
supply of blood to the parts, although the drug probably exerts 
some influence also upon the nerve-cells. The highest nerve- 
centers are first affected, so that a person who has taken alcohol 
displays a keener intelligence, a brighter wit, and possesses a sense 
of general mental and physical power. Should the dose have been 
large, depression is wont to succeed the feeling of exaltation, the 
functions in general sharing in the change, which passes from the 
highest to the lowest centers in regular succession, the order of 
functional disturbance being that of the cerebrum, cerebellum, 
spinal cord, and, lastly, the medulla oblongata. 

It will be observed that in this descending scale of functional 
derangement the mental faculties, being the highest, are earhest 
affected, resulting in failure of coordination in reasoning power 
and loss of control in the logical sequence of ideas, although the 
imagination, the emotions, and the faculty of speech may still re- 
tain their normal energy and exercise. Soon, however, the will- 
power succumbs ; the emotions, while yet stimulated, are no longer 



CARDIAC STIMULANTS. 5^7 

subject to mental command ; the imagination becomes disordered ; 
and the patient laughs and weeps hysterically, and, as a final result 
accompanying this stage of intoxication, the power of speech is 
merged in spasmodic, incoherent, or almost inaudible utterances 
or perhaps total dumbness. 

The muscular system, being less highly organized, may still 
retain its activity ; yet it at last yields to the influence of the poi- 
son, the movements becoming wholly incoordinate, until the patient 
sinks into a condition of drowsy, helpless stupor, in which he is 
incapable of the slightest effort dependent upon muscular energy. 

Consequent to this stage is the influence upon the spinal cord, 
the reflex centers in which are abohshed, the patient micturating 
and defecating involuntarily. Meanwhile the respiratory center, 
hitherto unaffected, shares the general influence of the drug. The 
breathing is difficult, or even paralyzed, and the face livid. At 
length the cardiac movements are involved, and, the paralysis 
affecting its functions — at first stimulated — fatal collapse ensues. 

A frequent phenomenon incident to the depression of the reflex 
centers is found in the fact that injuries which under normal condi- 
tions might prove fatal to the subject have little or no effect upon 
the system saturated with alcohol, the heart and respiratory appa- 
ratus being for the time immune against reflex action. 

Respiratory System. — Medicinal amounts deepen and accelerate 
respiration ; large doses render the breathing slow and shallow, — 
these effects being due to stimulation or depression of the respira- 
tory center. Death from a toxic dose of alcohol usually results 
from paralysis of respiration. It may be noted that under toxic 
dosage of the drug the amount of carbonic acid exhaled is dimin- 
ished. 

Absorption and Elimination. — Alcohol is very rapidly absorbed, 
and " ehminated unchanged in small proportion to the quantity in- 
gested," owing to the fact that the greater proportion of it is oxi- 
dized in the body. The kidneys, lungs, skin, and liver share in 
the excretory process. 

The quantity of urine is greatly increased, principally on account 
of increased arterial pressure, although the amount of urea, sodium 
chloride, and uric, phosphoric, and sulphuric acids in the urine is 
diminished by alcohol. 

When taken internally the amount of sweat is slightly increased, 
due partly to a direct stimulation of the sweat-glands, and partly 
to the dilatation of the cutaneous blood-vessels. 



568 A TEXT- BO OK OF MATERIA MEDIC A. 

Temperature. — Alcohol is an antipyretic of considerable power. 
This action is owing (i) to lessening of tissue-oxidation; (2) to the 
cooling of the blood through dilatation of the cutaneous blood- 
vessels, subjecting the warm blood from the interior of the body 
to the cooling influence of the atmosphere ; (3) to the cooling of 
the surface of the body from the evaporation of sweat. The power 
to resist cold is diminished by the habitual use of alcohol. The 
drug would be useful in stimulating warmth in a person who had 
been long exposed to cold, but only in a warm room. Then, by 
rapidly dilating the blood-vessels of the skin and allowing the 
blood to flow to the surface, the subject is favorably affected by 
the external heat, while there is less danger of congestion in some 
internal organ. 

Eye. — ^The excessive use of alcohol may produce amblyopia, 
watery eyes, and congested conjunctivae. 

Untoward Action is fully described under " Poisoning." 

Poisoning. — The untoward or poisonous action of alcohol may 
be divided into what are known as Acute and Chronic Alcoholism. 
The former has been described in detail under the effect of alcohol 
upon the Nervous System, and doubtless most readers are too 
familiar, from observation, with the effects of alcoholic intoxi- 
cation to require further enlightenment as to its general phe- 
nomena. 

A serious and altogether too frequent accompaniment of acute 
alcoholism is delirium tremens, the symptoms of which are as fol- 
lows : The malady is usually announced by marked anorexia, 
insomnia, and restlessness ; tremor, especially of the tongue ; dis- 
orders of vision and hearing ; great mental depression ; a soft 
and weak pulse ; and cold extremities. These manifestations are 
succeeded in a day or two by active delirium, even passing into 
wild mania and horrible hallucinations, in which the distorted 
imagination conjures up the most loathsome images of reptiles, 
the vivid spectacle of which preys upon the mind with pitiable 
terror and dismay. Even the tenderest offices in behalf of the 
sufferer are perverted by the disordered reason, which becomes 
possessed only with the sentiment of abject, agonizing fear. 

The muscles are in a constant tremor, and the patient talks in- 
cessantly and incoherently. The pulse is usually rapid, feeble, and 
dicrotic, and insomnia is continuous. The patient may even pass 
into a state of coma-vigil, which is generally the precursor of death, 
or fatal collapse may occur suddenly and unexpectedly. In other 



CARDIAC STIMULANTS: 569 

cases the sufferer may relapse into a sound sleep, when the delirium 
subsides and convalescence is established. 

It should be observed that alcoholic coma may be confounded 
with uremic coma, apoplexy, opium-narcosis, sunstroke, epileptic 
coma, or asphyxia. 

Diabetic or hysterical coma may also be confounded with alco- 
holic coma. So far as the odor of the breath is concerned, it is not 
pathognomonic, since a person in a comatose condition from other 
causes may have previously taken sufficient alcohol to impart to 
the breath a distinct odor of the drug. 

It is often, in fact, extremely difficult to make a positive diagno- 
sis of true alcoholic coma. It may sometimes happen that the 
patient is suffering from the combined action of alcohol and opium 
or noxious gases, or that he has been seized with cerebral hemor- 
rhage or sunstroke. 

Chronic alcoholism is generally the result of the continuous and 
excessive use of alcohol. The symptoms vary according to the 
individual case. There maybe (i) the moderate, daily drinker; 
(2) the periodical inebriate, usually the highly gifted, sensitive, and 
sympathetic, who drinks to excess at certain distinct intervals with 
a deliberation and moral perversity expressed by the declaration of 
a noted British general : " By the blessing of God, I intend to get 
gloriously drunk next Saturday night ;" (3) the immoderate, im- 
pulsive, maniacal inebriate, who, during his usually brief existence 
after the establishment of the disease, is subject to constant and 
excessive indulgence, incapacitating him from the simplest duties 
of a rational life. 

The habitual drinker sooner or later suffers from disturbed 
digestion, gastric catarrh, and irregularity of the bowels ; his face 
is usually puffed and bloated, while the capillaries, especially of the 
cheeks and nose, become permanently dilated, marked acne rosacea 
not infrequently developing in the latter organ. 

The excessive use of alcohol predisposes the subject to cirrhosis 
of the liver, other conditions being arterio-sclerosis, fatty degenera- 
tion of the heart and liver, paralysis, peripheral neuritis, Bright's 
disease, amaurosis, ataxia, epilepsy, insanity, etc. 

Treatment of Acute Alcoholic Poisoning. — The stomach should 
be emptied of all unabsorbed alcohol ; cautious inhalations of am- 
monia should be given, accompanied by the internal administration 
of the aromatic spirit of ammonia and black coffee. Capsicum and 
vinegar also have the power to stimulate the patient and counteract 



570 A TEXT-BOOK OF MA TERIA MEDICA. 

the ill effects of alcohol, while it is said that ammonium chloride, 
in a dose of 30 grains (2.0 Gm.) given in 8 ounces (236.59 Cc.) of 
water, is an exceedingly efficient antagonist. 

Should there be great depression of respiration, faradism of the 
muscles of respiration may be necessary, with warm applications to 
the extremities and cold to the head. Hot milk and other forms 
of nutritious liquid food form an essential element in the restoration 
of the patient. 

Treatment of Delirium Tremens. — The management of this phase 
of alcohoHsm requires great skill and judgment, the student being 
referred for details to any standard work on the Practice of Medi- 
cine. The indications are to quiet the patient and sustain his 
physical strength. This has been accomplished by the adminis- 
tration of chloral and potassium bromide or opium, these drugs, 
together with digitahs, strychnine, and other cardiac stimulants, 
having proved highly efficient remedies. Gastric sedatives may be 
required, such as bismuth, carbolic acid, hydrocyanic acid, etc. 

Nutritious and easily digested food should be given, and, in case 
of gastric intolerance, enemata should be adopted. 

Treatment of Chro?iic AlcoJiolism. — A thoughtful and extended 
experience with inebriates has convinced the author that the great 
majority of dipsomaniacs suffer from a disease possessing usually 
a distinct and traceable etiology and resulting from either inher- 
ited or acquired neurosis. In many cases the malady is charac- 
terized by uniform development, progress, symptomatology, and 
termination. 

The author makes this statement with the full knowledge that 
he will be regarded as a " sentimentalist " by many professedly 
** practical " men. Yet a careful scrutiny of numerous cases and a 
consideration of the means adopted in the treatment of them will, 
he believes, convince the thoughtful physician that he has to deal 
with a thoroughly diseased organism rather than with the victim 
of a "vicious drug habit " readily overcome by a moderate exercise 
of the will. 

The medicinal agents most serviceable in the treatment of 
chronic alcohoHsm are strychnine, atropine, small doses of the 
alteratives, arsenic, potassium iodide, and mercury, while phos- 
phorus and other restoratives and tonics will frequently be found 
useful. 

The hygienic surroundings should be of the best, and the treat- 
ment should include a nutritious, non-stimulating diet taken with 



CARDIAC STIMULANTS. 57^ 

regularity, and the free use of fruits and vegetables. Close atten- 
tion should be paid to the condition of the bowels and skin, and, 
among other remedial influences, should be mentioned laxatives 
when necessary, frequent Turkish baths, and, above all, change of 
scene and engaging mental occupation. 

From time to time various drugs have been heralded as specifics 
in the treatment of alcohohsm, certain " cures " {sic) acquiring an 
influence among the ignorant and unscientific wholly at variance 
with the therapeutic value of these vaunted remedies. It is super- 
fluous to say that to a skilled and enlightened professional judg- 
ment the rationale of intemperance and the agents serving to miti- 
gate the malady present a problem far too complicated to be 
grasped by the empirical understanding, operating even under the 
most ingenuous motives. 

Therapeutics. — Externally and Locally. — Alcohol is an efficient 
application for contusions, sprains, and indolent ulcers, and is also 
serviceable in hardening the skin and preventing the formation of 
bed-sores. It is a useful hemostatic to check capillary oozing, and, 
being a powerful antiseptic, is available in all wounds. Uterine 
hemorrhage is controlled by inserting in the cavity of the uterus a 
tampon saturated with the drug. 

Its local anesthetic properties render alcohol valuable in reheving 
irritation of the skin in urticaria, frost-bite , etc. ; it also serves as an 
efficient gargle in diphtheria and acute pharyngitis. 

Alcohol, or brandy, has been successfully employed to harden 
nipples and prevent their cracking. 

A very efficient means of reducing temperature in fever is to 
bathe the skin with alcohol, the method being also useful to check 
excessive sweating. 

The absorption of inflammatory exudates may be aided and the 
pain of muscular rheumatism relieved by rubbing the affected area 
with TINCTURE OF CAMPHOR or SOAP LINIMENT, both of which Con- 
tain alcohol. 

Internally. — Alcohol, in the form of wine, beer, or ale, taken 
before or during meals, is an efficient stomachic. Atonic dyspepsia 
and the weakened digestion attendant upon convalescence from acute 
diseases are greatly benefited by some form of alcohol When 
digestion becomes impaired as the result of physical or mental 
exhaustion the drug serves a useful purpose as a tonic. 

The wisdom of using the drug, however, in the above condi- 
tions may be questioned, because of the danger of establishing the 



572 A TEXT-BOOK OF MATERIA MEDICA. 

desire or habit, particularly in the case of neurotic women and 
those whose debilitated energies call for renewed and increasing 
quantities of the drug. 

Frequently the physical or mental depression, the peculiar, irre- 
sistible craving for stimulants, the insomnia and fitful appetite and 
disposition which urge recourse to alcoholic indulgence, are but 
the early manifestations of a brain-and-nerve degeneration, the 
impulse to drink being only the physical demand for relief 

There is less danger attending the administration of alcohol in 
conditions of lowered vitality and weakened digestion in old people 
than in the young and middle-aged. The drug is decidedly contra- 
indicated in persons of average health and fair digestion, although 
beneficial in the aged, whose powers are failing from natural 
decline. 

The anesthetic and sedative properties of alcohol, especially in 
the form of champagne, which contains carbon-dioxide gas, may 
frequently control obstinate vo^niting. Gastralgia and the pain 
arising from flatulence are often readily relieved by brandy, and 
the same remedy may be used efficiently in checking simple 
diarrhea. 

As a pure cardiac stimulant, alcohol is remarkably serviceable 
in syncope^ asphyxia^ exhausting hemorrhages, diphtheria, and col- 
lapse where death seems imminent. In counteracting the effects 
of narcotic poisons it is almost indispensable ; it is, moreover, un- 
doubtedly the most efficient antidote to the poison of venomous 
reptiles. 

It is a common practice with some surgeons to precede the 
inhalation of chloroform with the administration of i or 2 ounces 
(30.0-60.0 Cc.) of WHISKEY or brandy, for the twofold purpose of 
sustaining the heart and prolonging the anesthesia. 

In certain stages of various acute diseases, such as typhoid, 
typhus, small-pox, pnetimonia, cerebro-spijial meningitis, capillary 
bronchitis, etc., alcohol is one of the most potent and valuable rem- 
edies. It should be employed in these cases only when there is 
marked depression of the circulatory apparatus, characterized by 
a weak, rapid, soft, and irregular pulse, with a feeble sound of the 
heart and threatened syncope or deHrium. 

Alcohol is beneficial in such cases as the foregoing when by 
its use the tongue is moistened, the pulse and respiration is slowed, 
the restlessness and delirium quieted, and the skin becomes less 
parched. 



CARDIAC STIMULANTS. 573 

Should the drug increase the pulse and intensify the nervous 
manifestations, it is an indication that the dosage is excessive, in 
which event it may be well to discontinue the administration alto- 
gether. Even where the action of the drug is favorable, it is 
doubtful whether it should ever be given in fevers throughout the 
twenty-four hours, administration being advisable rather when the 
muffled or absent first sound of the heart indicates impending cardiac 
failure. This usually occurs during the interval between midnight 
and 7 a.m. Stimulation should therefore begin before midnight, 
and full doses — say i fluidounce (30 Cc.) — be given ever^^ three 
hours, full doses being of more service than repeated smaller 
amounts. 

It should be remembered that alcohol generates no new energy, 
but simply enables a person to utilize in a short period all his 
available reserve force. The utmost discrimination and judgment 
are requisite to the proper administration of the drug. 

In pyemia, septicemia, erysipelas, and diphtheria alcohol is fre- 
quently one of our most efficient remedies, while clinical experi- 
ence has fully demonstrated its value in retarding the progress of 
phthisis. Tubercular patients acquire a marked tolerance for the 
drug, being often able to assimilate enormous quantities without 
deleterious- results. 

Small quantities of alcohol appear to exert a favorable action 
in functional impotence. 

Its sedative action, or possibly its property of increasing intra- 
cranial blood-pressure, renders alcohol valuable as a hypnotic in 
neurasthenia. 

A very common remedy for anemia and chlorosis is red 

WINE. 

Acute coryza or a cold may often be wholly aborted by taking 
a good quantity of hot whiskey or hot " gin sling" upon retiring. 

The statement made by so prominent a physician as Mr. Law- 
son Tait, " I am fully persuaded, after thirty years of life as hard 
in work and as full of responsibility as well could be, that the mod- 
erate use of alcohol is a necessity in our modern life," is, in the 
author's opinion, too strong. Physicians, of all men, should realize 
the ill effects of over-work, as well as those of alcohol. Is it not 
wiser to limit the amount of labor than to attempt undue exertion 
under the stimulus of so seductive and dangerous a drug ? Sta- 
tistics show that of those addicted to the excessive use of alcohol 
and other pernicious drugs, by far the largest percentage is among 



574 A TEXT-BOOK OF MATERIA MEDICA. 

physicians — a sad commentary on their wisdom and professional 
knowledge. 

Contraindications. — Alcohol should not be given when the 
urine is of high specific gravity. It is ordinarily contraindicated 
in nephritis and diseases of the liver, gout, gleet, gonorrhea, and 
urethritis. The malt liquors and sweet wines should not be given 
in diabetes nor to persons suffering from eczema. Alcohol is also 
dangerous in hypertrophy of the heart and excessive cardiac 
action. 

Administration. — When possible, alcohol should always be 
taken with food. Brandy is the best astringent, and brandy and 
champagne are the best preparations to allay nausea. Whiskey is 
the least constipating, and gin the most diuretic. As regards 
their sedative action, there is no preference, whichever is most 
agreeable to the patient and least affects the head being advisable. 
As stomachics either claret, beer, or ale is most efficacious in im- 
proving the appetite. In cases of fermentative dyspepsia sweet 
wines and malted liquors are more injurious than beneficial, whiskey 
or brandy being preferable. 

When desired as diffusible stimulants in cases of cardiac failure 
brandy or whiskey only should be employed, which preparations 
may be given hypodermically. 

PREPARATIONS OF AMMONIUM. 

AquaAmm5niae Fortior— Aquae Ammoniae Forti5ris 
—Stronger Ammonia Water. TJ, S. JP. 

Origin. — An aqueous solution of ammonia (NH3 = 17.01), con- 
taining 28 per cent, by weight of the gas. 

Description and Properties. — A colorless, transparent liquid, 
having an excessively pungent odor and a very acrid and alkaline 
reaction. It should be kept in strong, glass-stoppered bottles. 

Dose. — 3-6 minims (0.18-0.3 Cc). 



Official Preparation. 

Spiritus Ammonise— Spiritus Ammoniae— Spirit of Ammonia. — Origin. — 
An alcoholic solution of ammonia, containing 10 per cent, by weight of the gas. 

Description and Properties. — A colorless liquid, having a strong odor of ammonia 
and a specific gravity of about 0.810 at 15° C. (59° F.). It should be kept in glass- 
stoppered bottles, in a cool place. 

Dose. — 10-60 minims (0.6-3.7 Cc). 



CARDIAC STIMULANTS. 575 

Aqua Ammoniae— Aquae Ammoniae— Ammonia 
Water. JJ. S. JP. 

Orig-in. — An aqueous solution of ammonia, containing lo per 
cent, by weight of the gas. 

Description and Properties. — A colorless, transparent liquid, 
having a pungent odor, an acrid, alkaline taste, and a strongly 
alkaline reaction. It should be kept in glass-stoppered bottles, in 
a cool place. 

Dose. — 10-20 minims (0.6-1.2 Cc.) well diluted. 

Official Preparations. 

LinimSntum Ammoniae— LinimSnti Ammoniae — Ammonia Liniment (Am- 
monia Water, 350; Alcohol, 50; Cotton-seed Oil, 600). — For external use. 

Spiritus Ammoniae AromSticus — Spiritus Ammoniae Aromatici. See Am- 
monium Carbonate. 

Ammonii Carbonas— Ammonii Carbonatis— 
Ammonium Carbonate. TJ. S. J*. 

Origin. — Prepared by subjecting to sublimation and resublima- 
tion a mixture of Ammonium Sulphate or Chloride and Calcium 
Carbonate. 

Description and Properties. — White, hard, translucent, striated 
masses, having a strongly ammoniacal odor without empyreuma, 
and a sharp, saHne taste. On exposure to air the salt loses both 
ammonia and carbonic acid, becoming opaque, and is finally con- 
verted into friable, porous lumps or a white powder. Slowly but 
completely soluble in about 5 parts of water ; decomposed by hot 
water, with the elimination of carbonic acid and ammonia. 

Ammonium carbonate should be kept in well-stoppered bottles, 
in a cool place. 

Dose. — 2-15 grains (o.i 2-1.0 Gm.). 

Official Preparation. 

Spiritus Ammoniae AromSticus — Spiritus Ammoniae AromStici — Aromatic 
Spirit of Ammonia (Ammonium Carbonate, 34; Ammonia Water, 90; Oil of Nut- 
meg, I; Oil of Lemon, 10 ; Alcohol, 700; Oil of Lavender Flowers, i; Water, to 
-make looo). — Description and Properties. — A nearly colorless liquid when freshly pre- 
pared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal 
odor and taste. It should be kept in glass-stoppered bottles, in a cool place. 

Dose. — ^-2 fluidrachms (1.8-7.3 Cc). 



Antag-onists and Incompatibles. — The cardiac sedatives are 



576 A TEXT-BOOK OF MATERIA MEDICA. 

antagonistic. The incompatibles are the vegetable and mineral 
acids, the earthy salts, lime water, and solutions of acidulous salts. 

Synergists. — Cardiac and diffusible stimulants, antispasmodics, 
and capsicum internally. The local action of ammonium prepara- 
tions is enhanced by cantharides and counter-irritants. 

Physiolog-ical Action. — Externally a7id Locally. — When solu- 
tions of ammonia are applied to the skin or mucous membranes 
they act as irritants, rubefacients, or vesicants according to the 
strength of the solution and the freedom or confinement of the 
vapor. 

When inhaled the vapor occasions great irritation of the respi- 
ratory passages, together with a sense of suffocation and spasmodic 
closure of the glottis. There are also produced marked irritation 
of the conjunctivae, lacrymation, and a watery secretion from the 
nose. 

Internally. — Digestive System. — Small doses act like alkalies 
upon the gastro-intestinal tract, augmenting the flow of gastric 
juice when given before meals and neutralizing it when given after 
meals. 

Excessive doses occasion violent and destructive inflammation 
of the mouth, esophagus, and stomach, possibly resulting in stric- 
ture of the esophagus and stenosis of the pyloric orifice. 

Circulatory System. — These preparations, whether ingested or 
injected into the system, cause a temporary fall of arterial pressure, 
quickly followed by a decided increase and acceleration of the pulse^ 
owing to stimulation of the accelerator nerves of the heart. Their 
precise action upon the blood is not known, though they certainly 
lessen the oxygen-carrying power of the red corpuscles and dimin- 
ish the tendency to coagulation of the blood. 

Nervous System. — Other than their action upon the sensory 
nerves when locally appHed, these preparations affect the nervous 
system only in stimulating the motor centers of the spinal cord, 
excessive doses causing convulsions. 

Respiratory System. — They stimulate the respiratory center, 
greatly increasing the number of respirations. 

Absorption and Elimination. — The preparations of ammonium 
are rapidly absorbed, being oxidized in the system and eliminated 
chiefly by the kidneys, increasing the acidity of the urine and aug- 
menting its amount, as well as increasing the proportion of nitric 
acid, uric acid, and urea excreted. The continued use of ammo- 
nium preparations therefore promotes tissue-waste. 



CARDIAC STIMULANTS. 577 

Temperature is unaffected by medicinal amounts. 

Poisoning. — In toxic doses these preparations are powerful cor- 
rosive poisons, exciting violent inflammation of the gastro-intestinal 
tract, labored respiration, great cardiac depression, muscular weak- 
ness, and possibly convulsions. 

Treatment of Poisoning. — Similar to that of poisoning by the 
corrosive alkalies — evacuation of the stomach, the internal admin- 
istration of vinegar or other vegetable acids, followed by oil and 
demulcent drinks, opium being indicated for the relief of pain. 

Therapeutics. — Aqua ammonia is a valuable ingredient of 
'' hair tonics " in prematiire alopecia. The ammonia liniment is a 
favorite remedy for cliilblains. 

The aromatic spirit of ammonia is of value in many diseases 
of the scalp, such as pityriasis, etc., and, when well diluted with 
water, has been recommended in acnte pharyngitis. The ammonium 
CARBONATE posscsses an action similar to that of salicylic acid in 
its property of dissolving epidermic scales, rendering it of value in 
preparing the skin for the subsequent local treatment of psoriasis. 

As a counter-irritant ammonia water — or, preferably, the am- 
monium LINIMENT — is efficient in chronic rheumatism and Joint 
affections. 

Ammonia water relieves the irritation caused by bites of insects ; 
its vapor inhaled acts as a rapid restorative in cases oi fainting. 

Internally. — The ammonium preparations here mentioned are 
serviceable in lessening excessive acidity of the stomacJi. The 
aromatic spirit of ammonia is frequently beneficial in allaying 
the distress of nervous headache, and is also an efficient remedy to 
counteract the effects of an immoderate use of alcoholic stimidants, 
having proved in many cases valuable in the treatment of delirium 
tremens. 

The most important uses of these preparations are, perhaps, as 
powerful diffusible stimulants to the circulatory, respiratory, and 
spinal systems. They are of undoubted value in sudden cardiac 
failure arising from any cause, such as poisoning from chloroform, 
noxious gases, hydrocyanic acid, etc. Taken internally or by intra- 
venous injection, they counteract the poisonous effects resulting 
from the bites of venomous reptiles. 

The carbonate is an excellent stimulant to sustain the heart 
and respiration during the course of pneumonia, eruptive and con- 
tiiiued fevers, etc. In all dynamic conditions of the heart this 
preparation should be given in small doses, frequently repeated. 

37 



578 A TEXT-BOOK OF MATERIA MEDTCA. 

The carbonate is also a valuable stimulant expectorant in chronic 
bronchitis and broncho-pneumonia. 

The preparations of ammonia have been recommended in 
threatened thrombosis. The condition being established, however, 
the only effective method of treatment is by intravenous injection, 
when the thrombi may be redissolved through direct contact with 
the remedy. 

Contraindications. — Acute gastritis and conditions of excessive 
acidity of the urine. Conditions of anemia and great emaciation 
would contraindicate the prolonged use of these preparations. 

Administration. — The liquid preparations should always be 
well diluted, and the carbonate should invariably be given in solu- 
tion. The fluid extract of glycyrrhiza disguises the taste very 
well. 

Owing to the rapid elimination of these drugs, the dosage 
should be frequently repeated. 



GROUP IX.— CARDIAC SEDATIVES. 

Aconltum— Aco nit i— Aconite. Z7. >S^. J^. 

Origin. — The tuber of Aconitum Napellns L., a plant about 
40 inches (i M.) high, met with throughout the greater portion 
of Asia and Europe, mostly in mountamous regions. 

Description and Properties. — From f to |- inch (10-20 Mm.) 
thick at the crown, and from 2 to 3 inches (50-75 Mm.) long, with 
scars or fragments of radicles ; dark brown externally, whitish in- 
ternally ; with a rather thick bark, the central axis about seven- 
rayed ; without odor, taste at first sweetish, soon becoming acrid, 
and producing a sensation of tingling and numbness lasting for 
some time. It contains an acrid alkaloid, aconitine. 

Dose. — \-2 grains (0.03-0.12 Gm.). 

Official Preparatiofts. 

Extractum Aconiti — ExtrScti Aconiti— Extract of Aconite. — Dose, J^-^ 
grain (0.006-0.01 Gm.). 

Extr^ctum Aconiti Fluidum — ExtrScti Aconiti Fiaidi — Fluid Extract of 
Aconite. — Dose, ^-^-2 minims (0.006-0.12 Cc). 

Tinctiira Aconiti — Tincturae Aconiti — Tincture of Aconite. — Dose, I-5 min- 
ims (0,008-0.3 Cc). 



CARDIAC SEDATIVES. 579 

Unofficial Preparation. 

Fleming's Tincture of Aconite is nearly twice as strong as the official tincture, 
the dose being correspondingly smaller, 

Aconitlna— Aconitlnae— Aconitine. (Unofficial.) 

Orig-in. — An alkaloid principle extracted from Aconite. 

Description and Properties. — The alkaloid exists in two forms, 
crystalline and amorphous ; white or yellowish-white, odorless, with 
a strong acrid taste characteristic of aconite. The crystalline form 
is soluble in alcohol, ether, and chloroform, and partially so in 
water. 

The alkaloid is one of the most powerful of poisons, rivalling in 
virulence hydrocyanic acid. The various aconitines are of different 
strengths, so that only the minimum dose of a new sample should 
at first be employed. 

Dose.- — xToo~T5"o" grain (0.00006-0.00025 Gm,). 

Oleatum Aconitlnae — Oleati Aconitinse — Oleate of Aconite. — A 2 per cent, 
solution of Aconitine in Oleic Acid, For external use. 



Antagonists and Incompatibles. — Digitalis and other cardiac 
stimulants, including atropine and ether, antagonize the action of 
aconite. 

Synergists. — All members of this group and cold enhance the 
action of the drug. 

Physiolog'ical Action. — Externally and Locally. — Applied to 
mucous membranes or to the skin for any length of time, aconite 
first stimulates and then depresses the ends of the sensory nerves, 
producing respectively tingling, numbness, and local anesthesia. 

Internally. — Digestive System. — Except when given in very di- 
lute solutions, aconite produces tingKng and numbness of the lips 
and mouth, with increased secretion from the salivary glands. 
Large doses cause great irritation, together with a sense of con- 
striction in the fauces. 

Under normal conditions of the stomach aconite may act upon 
that organ as a sedative, augmenting its secretions. Large doses 
may occasion pain, nausea, and vomiting. 

Circulatory System. — Aconite causes a marked slowing of the 
heart's action, due to stimulation of the vagus center in the me- 
dulla. Following the slowing of the heart, due to vagus action, 
aconite has a direct action on the heart-muscle, increasing its irri- 



58o A TEXT-BOOK OF MATERIA MEDICA. 

tability, causing it to become very rapid and weak, eventually occa- 
sioning delirium cordis through over-stimulation. Death usually 
occurs from cardiac paralysis, the heart being arrested in diastole. 
The arterioles are contracted, owing to stimulation of the vaso- 
motor center in the medulla ; but because of this action, occasion- 
ing a marked slowing of the heart, there is a great decrease of 
blood-pressure. Moreover, the contractive action of the vaso- 
motor center is somewhat counteracted by its primary stimulation 
of the cutaneous nerves, resulting in dilatation of the peripheral 
vessels and consequent flushing of the skin. 

Nervous System. — Excessive doses of aconite cause a slight 
stimulation of the sensory nerve-endings, finally followed by 
depression, the muscles passing into a state of paralysis, probably 
occasioned by direct action upon the muscle-tissue. 

Respiratory System. — The respiration is slowed by moderate 
doses ; under large doses it is rendered both shallow and slow. 
The breathing is retarded, .because the peripheral endings of the 
vagi distributed to the lungs are depressed. Under large doses 
there is depression of the respiratory center, paralysis of which 
may be occasioned by lethal amounts. 

Absorption and Elimination. — Aconite is rapidly absorbed, but 
its channels of elimination are not definitely known, although it is 
probably excreted by the kidneys, and to some extent by the skin, 
the drug acting as a mild diaphoretic. 

Temperature. — Aconite is alleged to be a decided antipyretic, the 
reduction of temperature being due to various causes : (i) the slow- 
ing of the circulation, diminishing the metabolism ; (2) the peripheral 
action of aconite, causing dilatation of the cutaneous blood-vessels ,-^ 
(3) the depressing action of the drug upon all muscle-tissue. 

Eye. — Toxic amounts of the drug have produced mydriasis,, 
misty vision, and diplopia. 

Untoward Action. — Besides the sym.ptoms described under 
" Poisoning," there have been observed pustular and erythematous 
eruptions, vertigo, and dimness of vision. 

Poisoning. — The first effect of toxic doses is to cause marked 
tingling of the tongue and lips, which sensation soon extends to 
the fingers and may even affect the entire cutaneous surface. There 
is extreme muscular weakness, particularly noticeable in the lower 
extremities. The pulse, at first slow and weak, soon becomes rapid 
and almost imperceptible. The respirations are quite feeble and 
shallow, and there may be marked dyspnea. 



CARDIAC SEDATIVES. 581 

The countenance is anxious and the skin pallid, cold, and cov- 
ered with sweat, with great reduction of temperature. These symp- 
toms are accompanied by dimness of vision, the pupils usually being 
widely dilated. Rarely there are present epileptiform convulsions. 

Death may be postponed for some time, or it may rapidly follow 
a lethal dose. 

Treatmeiit of Poisoning. — The patient should be placed in a 
horizontal position, better with the feet raised slightly. The 
stomach should be thoroughly evacuated ; bodily heat should be 
maintained by external warmth ; diffusible stimulants, such as ether, 
alcohol, and spirits of ammonia should be given hypodermically, 
the treatment being followed by administration of digitalis. Atro- 
pine and strychnine hypodermically are indicated to stimulate the 
respiration and assist in stimulating the heart. 

Therapeutics. — Whether locally applied or given internally 
ACONITE is an excellent remedy in neiiralgice, particularly in tic 
douloureux. The tincture, aconite liniment, or an ointment of 
ACONiTiNE may be applied to the course of the affected nerve. The 
tincture OF ACONITE frequently proves beneficial in herpes zoster, 
chilblain, pruritus, etc., and its extended application has even been 
recommended to allay the pain of chronic rheumatism. 

Internally. — Aconite is an exceedingly efficacious remedy in 
many febrile diseases, particularly the stJienic fevers of children and 
those fevers resulting from inflammation, such as tonsillitis, laryn- 
gitis, pharyngitis, guijisy, etc. The drug seems to exert a pecu- 
liarly beneficial influence on mucous membranes, all acute inflam- 
matory conditions of the throat, bronchial tubes, or intestinal canal 
— characterized by fever, a small, wiry pulse, and rapid cardiac 
action — being greatly improved by the remedy. 

As previously indicated, aconite is one of the most efficient 
sedatives in the irritative fevers of children. It is equally valuable 
in \\\^ first stage of pneumonia and m pleurisy, and is an invaluable 
adjunct to opium in the treatment oi peritonitis. 

Pericarditis is often favorably influenced by this drug, while it is 
also of great service in allaying nervous palpitation of the heart or 
that due to excessive cardiac hypertrophy. 

The injection into the rectum of 8 or 10 minims (0.5-0.6 Cc.) of 
the TINCTURE OF ACONITE, while perhaps producing a slight pro- 
lapsus of the rectum, quickly affects an irritable stricture of the 
urethra, so that a catheter may be passed with little difficulty, al- 
though the operation may have been previously found impossible. 



582 A TEXT-BOOK OF MA TERIA MEDICA. 

Probably there is no better combination to "break up a cold'* 
than aconite and Dover's powder, the tincture of aconite, given at 
frequent intervals for a few hours, being followed, preferably at bed- 
time, with 8 or 10 grains (0.5-0.6 Gm.) of Dover's powder. 

Aconite has been favorably recommended in the acute stages of 
cerebrospinal meningitis and as a cardiac sedative in aneurysm. 

Contraindications. — Aconite is always contraindicated in sub- 
acute or chronic conditions or when the heart's action is weak. It 
is also intolerable in catarrhal conditions of the stomach. 

Administration. — A good, reliable tincture is the best prepara- 
tion for internal use. Moreover, better results are obtained by 
giving the drug in fraction of minim doses — from iV to ^ minim 
(0.006-0.03 Cc.) in a teaspoonful of water every fifteen minutes — 
than by larger dosage. The most desirable influence of the drug 
appears to be realized by this method. 

Veratrum Viride— Veratri Viridis— Veratrum Viride. 

V. S. I'. 

(American Hellebore.) 

Origin. — The rhizome and roots of Veratrnm viride Solander, a 
plant growing in swampy places and damp thickets in Canada, and 
in the United States as far south as Georgia. The plant closely 
resembles V. album of Europe, and is also allied to a species found 
in Eastern Siberia. 

Description and Properties. — Rhizome upright, obconical, 
simple or divided, from 2 to 3 inches (50 to 75 Mm.) long; exter- 
nally blackish-gray, internally grayish-white, showing numerous 
short, irregular wood-bundles. Many shrivelled, light yellowish- 
brown roots issue from all parts of the rhizome. 

The drug is inodorous, but strongly sternutatory when pow- 
dered, the taste being bitterish and very acrid. 

Veratrum viride contains the following alkaloids : jervine, psen- 
dojervine, rubijervine, and cervadine. The first named is the cardiac 
depressant principle of the drug, and the remaining three are ster- 
nutator}\ 

Veratrina (U. S. P.) is not found in this drug, as formerly sup- 
posed, Sabadilla being its principal source. Veratroidine, once 
supposed to be a distinct alkaloid, is probably only a mixture of 
rubijervine and a toxic resin. 

Dose. — 1-5 grains (0.OI-O.3 Gm.). 



CARD I A C SEDA TI VES. 583 

Official Preparations. 

ExtrSctum Veratri Viridis Fluidum — ExtrScti Veratri Viridis Fluidi — 
Fluid Extract of Veratrum Viride. — Dose, i-5 minims (0.01-0.3 Cc). 

Tinctura Veratri Viridis — Tincturae Veratri Viridis — Tincture of Veratrum 
Viride (40 per cent.). — Dose, \-^ minims (0.01-0.3 Co.). 

Allied Drugs. 

Veratrum Album — Veratri Albi — White or European Hellebore. 
Sebadilla— Sebadillffi— Cevadilla. 

The seeds of this plant yield the following official alkaloid, known as Veratrine : 

Veratrlna— Veratrlnae— Veratrine. TJ. S. P. 

Description and Properties. — A white or grayish-white, amor- 
phous or semi-crystaUine powder; odorless, but causing intense 
irritation and sneezing whenever even a minute quantity reaches 
the mucous membrane ; of an acrid taste, and leaving a sensation 
of tingling and numbness on the tongue ; permanent in the air ; 
very slightly soluble in hot or cold water, soluble in 3 parts of 
alcohol. 

Dose. — ^Q— i grain (0.0016-0.016 Gm.). 

Official Preparations. 

Oleatum Veratrinae — Oleati Veratrlnae — Oleate of Veratrine (2 per cent.). 
For external use. 

UnguSntum Veratrlnae — UnguSnti Veratrlnae — Veratrine Ointment (4 per 
cent.). For external use. 

Antagonists and Incompatibles and Synergists are the same 
as for Aconite. 

Physiological Action. — The following remarks refer only to 
the crude drug, the actions oi Jervine, the mixture Veratroidine , 
and Veratrine being given separately. 

Externally and Locally. — Veratrum is more of an irritant than 
aconite, exciting some inflammation of the skin when applied locally, 
and when in contact with the nasal mucous membrane producing 
violent sneezing. 

Internally. — Its effects are in every respect analogous to those 
of aconite, with the following exceptions, in the several systems : 

Digestive System. — Veratrum is more apt to occasion nausea 
and vomiting. 

Circidatory System. — The drug is a more powerful depressant 
to the circulation, small doses, while not materially affecting the 



584 A TEXT-BOOK OF MATERIA MEDICA. 

pulse-rate, greatly reducing its force, large doses rendering the 
pulse very weak, almost indistinguishable, and very rapid. 

Nervous System. — It does not, as does aconite, affect the sen- 
sory nerves, but in large doses paralyzes the motor system cen- 
trally, impairing the reflexes. Under moderate doses there is 
extreme muscular weakness. 

Respiratory System. — Veratrum depresses the respiration less 
than aconite. 

Absorption and Elimination. — The drug is absorbed with great 
facility, and is ehminated chiefly by the bowels. It possesses much 
feebler diuretic and diaphoretic properties than aconite. 

Temperature. — In medicinal doses it is not so powerful an anti- 
pyretic as aconite. 

Untoward Action. — Veratrum occasionally produces an erythem- 
atous or pustular eruption. 

Poisoning. — Except that the drug causes no cutaneous anesthe- 
sia or diminution of sensation, the symptoms of poisoning are 
almost identical with those occasioned by aconite. 

Treatment of Poisoning. — The same as prescribed for aconite. 

The Physiolog'ical Actions of jervine, veratroidine, and vera- 
trine are as follows : 

Externally and Locally. — Jervine is a mild irritant when applied 
to the skin or mucous membranes. Veratroidine is less irritating 
when similarly applied. Veratrine is a powerful irritant when 
appHed by inunction, producing a tingHng or prickling sensation, 
followed by pain and finally by numbness. 

Internally. — Digestive System. — Jervine has no noticeable effect 
upon the stomach and bowels, but produces marked salivation. 
Veratroidine in full doses occasions vomiting and purging. Vera- 
trine excites great irritation of the gastro-intestinal tract, causing 
profuse salivation, with vomiting and purging and severe epigas- 
tric pain. 

Circulatory System. — Jervine renders the pulse slower, softer, 
and fuller, with marked reduction of arterial pressure. This action 
is due to direct depression of the cardiac muscle or of the motor 
ganglia, the dilatation of the arterioles being the result of a de- 
pressant effect upon the vaso-motor center. 

Veratroidine retards the heart's action by stimulating the pneu- 
mogastrics. The arterial pressure is lowered by weakening of the 
heart. The vaso-motor center is not depressed, nor are the arte- 
rioles dilated. 



CARDIAC SEDATIVES. 585 

Veratrine markedly retards cardiac action, lengthening the 
diastolic period. The blood-pressure is decreased. 

Nervous System. — Jervine causes great muscular weakness, with 
abolition of reflexes, owing to its depressing action upon the motor 
areas of the spinal cord. Upon the cerebral motor areas, however, 
its influence is that of a stimulant, so that poisonous doses of this 
alkaloid produce convulsions of cerebral origin. The muscles 
themselves and the motor nerves are unaffected, though in the 
later stage of poisoning numbness is present, showing that some 
portion of the sensory mechanism is depressed. 

Veratroidine manifests the same action as jervine. 

Veratrine. — This alkaloid affects neither the brain nor the 
spinal cord. The motor and sensory nerves, on the other hand, 
betray its influence, being first stimulated and then paralyzed. 

The pain primarily produced by the local application of vera- 
trine is due to excessive stimulation of the peripheral endings of 
the sensory nerves. 

Respiratory System. — Jervine is a powerful depressant to the 
respiration, death occurring from asphyxia when lethal doses are 
taken. 

Veratroidine affects the sy stern in like manner with jervine. 

Veratrine. — Small doses accelerate the respiratory movements. 
Large doses retard and finally arrest respiration — the former 
amounts acting as stimulants, and the latter causing paralysis of 
the respiratory center. 

Temperature. — Moderate amounts of jervine and veratro- 
idine have no marked effect upon, while poisonous doses depress, 
temperature. 

Veratrine in large doses is more of an antipyretic than either 
jervine or veratroidine. 

Poisoning. — The symptoms of poisoning from either one of the 
above alkaloids would be a combination of the effects produced 
by lethal amounts, as stated, separately. 

Treatment of Poisoning. — The same as prescribed under Vera- 
trum Viride. 

Therapeutics. — Externally and Locally. — Veratrum viride is 
seldom, if ever, used locally. Veratrine, though in rare cases 
given internally, is wellnigh restricted to external or local appli- 
cation. 

The OLEATE or ointment of veratrine when applied over the 
affected nerve is exceedingly efflcacious in neuralgia, particularly 



586 A TEXT-BOOK OF MATERIA MEDICA. 

in tic douloureux and orbital neuralgia. In the latter affection great 
care should be taken in administration, lest some portion of the 
drug enter the eye, in which case violent and persistent conjuncti- 
vitis would ensue. 

Internally. — Veratrum viride may be employed for the same 
conditions for which aconite is recommended, although it is doubt- 
ful whether it possesses any advantages over the latter drug ; in- 
deed, by many competent physicians it is considered inferior to, 
and more dangerous than, aconite. Moreover, the nausea and 
vomiting which in many patients are likely to follow the ingestioa 
of this drug render its use objectionable. 

Contraindications. — The same as for aconite. 

Administration. — The tincture of veratrum viride only should 
be given, beginning with small doses, as recommended for aconite,, 
and cautiously increasing the amount. Veratrine may be applied 
in the form of an ointment, oleate, or in solution together with 
alcohol and glycerin. 

Phytolaccae Fructus— Phytolaccae Fructus— Phyto- 
lacca Fruit. JJ. S. JP. 

Origin. — The fruit of Phytolacca decandra L., a perennial herb 
indigenous in North America, growing in waste places. 

Description and Properties. — A depressed-globular, dark- 
purple compound berry, about \ inch (8 Mm.) in diameter, com- 
posed of ten carpels, each containing one lenticular black seed ; 
juice purplish-red, inodorous; taste sweet, slightly acrid. The 
fruit contains pkytolaccin, phytolaccic acid, tannin, gum, sugar, and 
a coloring matter. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Phytolaccae Radix— Phytolaccae Radicis— Phyto- 
lacca Root. JJ. S. JP. 

(Poke-root.) 

Origin. — The root of Phytolacca decandra L. 

Description and Properties. — Large, conical, branched, and 
fleshy ; mostly in transverse or longitudinal slices, wrinkled, gray- 
ish, hard; fracture fibrous, the wood-bundles in several distinct 
concentric circles ; inodorous ; taste sweetish and acrid. It con- 
tains resin, gum, fixed oil, tannin, starch, sugar, and a glucosid. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 



CARDIAC SEDATIVES. 5^7 

Official Preparation. 

ExtrSctum Phytoiaccae RSdicis Fluidum — Extr^cti Phytoiaccae R^dicis 
Fluidi — Fluid Extract of Phytolacca Root. — Dose, 5-3° minims (0.3-2.0 Cc). 

Antagonists and Incompatibles. — The cardiac stimulants, 
opium, and ether oppose the action of phytolacca. 

Synergists. — All the members of this group; the motor- 
depressants and emetics also enhance the action of the drug. 

Physiological Action. — Exteimally and Locally. — The pow- 
dered root is extremely irritating to mucous membranes, in certain 
subjects occasioning an erythematous eruption and excoriations. 

Internally. — Digestive System. — Phytolacca possesses emeto- 
cathartic properties. It occasions much nausea, with great de- 
pression, persisting for some time before vomiting occurs. The 
drug augments the secretion of bile and acts as a laxative. 

Circulatory System. — Like aconite, it reduces the force and fre- 
quency of the heart's action and lowers arterial tension. 

Nervous System. — Poke-root is a powerful motor depressant, 
acting as a direct paralyzant to the spinal cord and medulla, 
although the muscles and motor nerves are unaffected. 

Respiratory System. — Phytolacca is a respiratory depressant, 
rendering the breathing slow and shallow. Toxic doses produce 
death by paralysis of the respiratory center, preceded by tetanic 
convulsions. 

Absorption and Eliinination. — The drug is readily absorbed, and 
is eliminated chiefly by the kidneys. 

Temperature. — Medicinal doses have no effect on temperature. 

Poisoning.— Tho; symptoms of poisoning are quite similar to 
those produced by veratrum, though the nausea and vomiting are 
postponed longer after the ingestion of phytolacca. 

Treatment of Poisoning. — The same as recommended under 
Aconite and Veratrum. 

Therapeutics. — Externally and Locally. — Preparations of phyto- 
lacca have been successfully used to allay inflammatioji, as in cases of 
follicidar pharyngitis, tonsillitis, mastitis, ulcers, buboes, burns, abscesses. 
The drug is also useful in chronic eczema, sycosis, favus, etc. The 
FLUID EXTRACT may be applied, or the powdered root incorporated 
in ointment either singly or associated with other medicinal agents. 

Internally. — The drug has proved an efficient remedy in clironic 
rheumatism, its alterative properties rendering it also of some service 
in the treatment of scrofula, syphilis, and chronic diseases of the skin. 



588 A TEXT-BOOK OF MATERIA MEDICA. 

In mastitis, follicular phaiyngitis, tonsillitis, etc. the internal use 
of the drug is indicated, mastitis especially often yielding readily 
to the internal use of the fluid extract, combined with the local 
application of an ointment containing phytolacca. 

It has been recommended in obesity, possessing undoubted 
efficacy in this respect. It is claimed that the proprietary prep- 
aration known as *'Anti-fat" is a resinoid preparation of the berries. 

Contraindications. — The same as for veratrum viride. 

Administration. — No special directions are necessary. The 
powder, tincture, or fluid extract may be given internally; for 
topical use an ointment may be prepared. 

Pulsatilla— PuIsatTllae— Pulsatilla. 77. >S^. 1>. 

Origin. — The herb of Aiteinone Pulsatilla and Aitemoue pra- 
tensis L., collected soon after flowering. 

Description and Properties.— Leaves radical, petiolate, silky- 
villous, twice or thrice deeply three-parted or pinnately cleft, with 
Hnear, acute lobes, appearing after the large purple flowers; in- 
odorous, very acrid. It contains a peculiar, acrid, crystallizable 
principle known as ane7nonin. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparations. 

Extractum Pulsatillae— ExtrScti Pulsatillse — Extract of Pulsatilla. — Dose, 
J~3 grains (0.03-0.2 Gm.). 

Tinctura Pulsatillae— Tincturae Pulsatillse— Tincture of Pulsatilla.— Z>oj^, 
10-20 minims (0.6-I.2 Cc). 

Anemonin. — Occurring in crystalline, colorless needles, soluble in warm alcohol, 
insoluble in water. 

Antagonists and Inconipatibles and Synergists the same as 
for Aconite. 

Physiological Action. — Externally and Locally. — Pulsatilla is 
a decided irritant to the skin, the bruised plant when rubbed upon 
it even producing vesication. In the mouth it produces a sensation 
of burning, succeeded by numbness. 

Internally. — The action of the drug is identical with that of 
aconite, though pulsatilla possesses greater emetic properties. 

Therapeutics. — The drug may be employed for the same pur- 
poses as aconite, though as a cardiac sedative it is less efficient. It 
has been recommended as a useful emmenagogue. 



CARDIAC SEDATIVES. 589 

Arnicae Flores— Arnicae Florum— Arnica Flowers. 

V. S. JP. 

Origin. — The flower-heads of Arnica montaiia L., a plant in- 
digenous in the mountainous regions of Europe and Northern 
Asia, and also found in the northwestern part of America. 

Description and Properties. — Heads about i to 2 inches (25-50 
Mm.) in diameter, depressed-roundish, consisting of a scaly in- 
volucre in two rows, and a small, nearly flat, hairy receptacle, 
bearing about sixteen yellow, strap-shaped, ten-nerved ray-florets 
and numerous yellow, five-toothed, tubular disk-florets, with slen- 
der, spindle-shaped akenes crowned by a hairy pappus. Odor 
feeble and aromatic ; taste bitter and acrid. 

Arnica flowers contain a glucosid (?), arnicin, a volatile oil^ 
capronic and caprylic acids, resins, tannin, etc. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Pi'eparation. 

Tinctura Arnicse Florum — Tincturas Arnicae Florum — Tincture of Arnica 
Flowers (20 per cent.). — Dose, 10-30 minims (0.6-2.0 Cc). Chiefly, however, used 
externally as a vulnerary. 

Arnica Radix— Arnicae Radicis— Arnica Root. 

Z7. 8. B. 

Origin. — The rhizome and roots of Arnica mo7itana L. 

Description and Properties. — The rhizome is horizontal, some- 
what contorted, 2 to 3 inches (5-7 Cm.) long, and ^ or i- (3 or 4 
Mm.) or less in diameter, externally brown, rough from leaf-scars, 
internally whitish, with a rather thick bark containing a circle of 
resin-cells surrounding the short, yellowish wood-wedges, and a 
'large, spongy pith. The roots are numerous, thin, fragile, grayish- 
brown, with a thick bark containing a circle of resin-cells. Odor 
somewhat aromatic ; taste pungently aromatic and bitter ; the con- 
stituents the same as those of the flowers. 

Dose. — 5-30 grains (0.3-2 Gm.). 

Official Preparatio7ts. 

Extractum Arnicae Radicis Fluidum — ExtrScti Arnicae RSdicis Fluidi — 
Fluid Extract of Arnica Root. — Dose, 5-30 minims (0.3-2.0 Cc). 

ExtrSctum Arnicse Radicis — ExtrScti Arnicae RSdicis — Extract of Arnica 
Root. — Dose, 2-5 grains (0.13-0.3 Gm.). 

EmplSstrum Arnicae — EmplSstra Arnicae — Arnica Plaster [T,-}i P^r cent, of 
extract). For external use. 



590 A TEXT-BOOK OF MA TERIA MEDICA. 

Tinctura Arnicse RSdicis — Tincturse Arnicse RSdicis — Tincture of Arnica 
Root (lo per cent.). — Dose, 20-30 minims (1.3-2.0 Cc). 

Antagonists and Incompatibles and Synergists are the same 
as for Aconite. 

Physiological Action. — Externally and Locally. — The local 
action of both the root and flowers is irritant, that of the latter 
being the more powerful. Occasionally tincture of arnica flowers 
produces marked inflammation of the skin, resembling erysipelas. 

Internally. — The internal effects of arnica are as yet imperfectly 
understood, it being difficult to assign the drug to its proper group. 

Digestive System. — ^Small doses slightly stimulate the digestive 
apparatus. Large amounts produce nausea, vomiting, and diarrhea 
of a choleraic character. 

Circulatory System. — Small doses stimulate the heart and in- 
crease arterial pressure ; full or large doses retard the pulse and 
depress the circulation. 

Nervous System. — Large amounts cause headache, with great 
depression of the nerve-centers. Toxic amounts occasion motor 
and sensory paralysis, coma, at times convulsions, collapse, and 
death. 

Respiratory System. — The respiration is slowed, although under 
small doses there may be temporary acceleration. 

Absorption a?id Elimination. — The active principle of arnica dif- 
fuses readily into the blood, the drug being eliminated chiefly by 
the kidneys, though the skin shares in the excretory process. 

Temperature. — Large doses cause a reduction of temperature. 

Untoward Action. — The topical application of arnica may cause 
in susceptible persons violent cutaneous inflammation and the pro- 
duction of pustules, or even distinct bullae, attended with marked 
constitutional symptoms. When taken internally the drug occa- 
sions a sensation of burning in the mouth and throat, violent pain 
in the stomach, tenesmus, and choleraic diarrhea, intense headache, 
and dizziness. 

Poisoning. — In addition to the above-named symptoms there are 
great cardiac depression, decided muscular weakness, slow and 
shallow respiration, paralysis of the nervous system, and death 
resulting from collapse. 

Treatment of Poisoning. — The treatment should be much the 
same as that prescribed under Aconite. Atropine is probably the 
best physiological antidote. 

Therapeutics. — Externally a?id Locally. — Arnica enjoys a well- 



CARD! A C SEDA TI VES. 591 

deserved reputation as an efficient remedy for the relief of bruises, 
sprains, and exteriial iiiflanimations generally. It has been recom- 
mended also as a topical application in myalgic rliciiniatism. The 
local application of the tincture causes the rapid disappearance of 
ecchymoscs. Equal parts of the tincture of arnica and glycerin, 
diluted with water, have been recommended as a stimulant in 
inflammation of the mncoiis membrane of the month. 

Internally. — Arnica is not a very popular remedy for internal 
administration. It has, however, been used with varying success 
in idiopathic mania, delirium tremens, and rheumatic gout. It has 
also been beneficially employed in cxJiausting diarrliea, cJironic dys- 
entery, epis taxis, Jiemoptysis, and paralysis of the bladder. 

Contraindications. — Externally when there exists any acute 
skin disease ; internally in cases of inflammation of the gastro-in- 
testinal tract, fatty or valvular disease of the heart, and in all 
asthmatic conditions. 

Administration. — The tincture of arnica is the form generally 
preferred for external and internal use. In applying any prepara- 
tion externally the susceptibility to the irritating properties of the 
drug peculiar to certain persons should be remembered. 

Potassii NItras— Potassii Nitratis— Potassium 
Nitrate. V.S.l^. 

(Nitre; Saltpetre.) 

Origin. — Purified from native Saltpetre. 

Description and Properties. — Colorless, six-sided, rhombic 
prisms, or a crystalline powder; odorless, and having a coohng, 
saline, and pungent taste. Permanent in the air. Soluble in 3.8 
parts of water, very sparingly soluble in alcohol. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Official Preparations. 

ArgSnti Nitras Dilutus — ArgSnti Nitratis Diluti — Diluted Silver Nitrate. 

— Used extei-nally. 

ChSrta Potassii Nitratis — Ch^rtas (ace.) PotSssii Nitratis — Potassium 
Nitrate Paper. — Intended for burning, the fumes to be inhaled. 

Antagonists and Incompatibles. — Cardiac and diffusible stim- 
ulants antagonize the action of potassium nitrate upon the heart. 
Mineral acids and metallic salts are incompatible. 

Synergists. — The cardiac depressants, diuretics, and agents 
increasing waste aid the action of potassium nitrate. 



592 A TEXT-BOOK OF MATERIA MEDIC A. 

Physiolog-ical Action. — Externally and Locally. — The drug has 
no important local action. 

Internally. — Digestive System. — Large doses occasion nausea 
and vomiting; poisonous doses produce violent gastro-intestinal 
inflammation and diarrhea, blood sometimes being vomited and 
passed with the stools. 

Circulatory Syste^n. — Small doses have no marked influence on 
the circulatory system ; full doses act as a cardiac depressant, slow- 
ing and weakening the pulse ; poisonous doses produce great weak- 
ness, syncope, and death from cardiac failure. 

Nervous System. — No special action is noticeable, although poi- 
sonous doses produce tremulousness, insensibility, and convulsions. 

Respiratory System. — Large doses retard respiration. 

Absorption and Elimination. — Potassium nitrate passes rapidly 
into the blood unchanged, and is ehminated by the kidneys un- 
changed. Small doses are actively diuretic, stimulating the renal 
cells. Large amounts, from too free stimulation, are apt to irri- 
tate and inflame the kidneys, even so far as to produce hematuria. 
The drug is also ehminated to some extent by the skin, being 
therefore a mild diaphoretic. 

Temperature. — Unaffected by medicinal amounts, but lowered 
by poisonous doses. 

Poisoning. — There is violent gastro-intestinal inflammation, with 
vomiting and purging, blood being present in the ejecta and feces. 
Other symptoms are — subnormal temperature, coldness of the ex- 
tremities, a weak and thready pulse, slow and shallow respiration, 
tremulousness and great muscular weakness, dimness of vision or 
total bhndness, deafness, insensibility, and possibly convulsions. 
The urine is diminished or suppressed. 

Should the patient recover from an immoderate dose of the 
drug, he suffers for some time from dysuria, irritability of the 
stomach, colic, muscular weakness, and a sensation of chilliness 
in the back and limbs. 

Treatment of Poisoning. — There is no special antidote for nitre ; 
cases of poisoning, therefore, are to be treated symptomatically, 
measures for rehef including evacuation of the stomach, de- 
mulcents, opiates for pain, and cardiac and respiratory stim- 
ulants. 

Therapeutics. — Exter7ially and Locally. — Solutions of this drug 
have been found serviceable as applications to bruises and abrasions. 
The last stage of pharyngitis is greatly relieved by a gargle of a 



CARDIAC SEDATIVES. 593 

SOLUTION OF POTASSIUM NITRATE, ill the proportion of I drachm 
(4.0 Gm.) to I pint (473 Cc.) of water. 

It is claimed that a paste of powdered nitre and water applied 
to the face night and morning is an effective method of removing 
freckles. 

The difficulty of breathing in cases of spasmodic asthma may 
be greatly relieved by the inhalation of the fumes of burning 
nitre- paper. 

Internally. — The drug was formerly much used in acute artic- 
ular rheum,atism and as a refrigerant and sedative in inflammations, 
pneumonia, and various fevers. It is employed to a considerable 
extent as a diuretic and diaphoretic, although greatly inferior to the 
acetates and citrates. 

Administration. — It should be given in solution, though the 
powder is sometimes used in combination with calomel, tartar 
emetic, or Dover's powder. 

The potassium-nitrate paper, as has been stated, should be 
burned and the fumes arising therefrom inhaled. 

Sodii NTtras— S5dii Nitratis— Sodium Nitrate. 

TJ. S.JP. 

Origin. — It is found in great quantities imbedded in clay and 
sand in certain districts of Chili and Peru. 

Description and Properties. — Colorless, transparent, rhombo- 
hedral crystals, odorless, having a cooHng, saline, and slightly bit- 
ter taste; deliquescent in moist air. Soluble in 1.3 parts of water 
and in about 100 parts of alcohol. Sodium nitrate should be kept 
in well-stoppered bottles. 

Dose. — J-i ounce (i 5.5-31.0 Gm.). 

Physiological Action. — The action of the salt resembles closely 
that of potassium nitrate, though it is much feebler than the latter 
drug, while possessing greater purgative properties. 

Therapeutics. — Externally and Locally. — A solution of the salt 
possesses some power as a solvent of false membranes, and has 
been used in the form of a spray to diminish flbriizous exudations 
in the pharynx and larynx. 

Internally. — It may be employed for the same purposes as the 
potassium nitrate, and has been advantageously adopted as a laxa- 
tive in diarrhea and dysentery. 

Administration. — Sodium nitrate is best given dissolved in a 
large quantity of water. 

38 



594 A TEXT-BOOK OF MA TERIA MEDICA. 

GROUP X.— DIAPHORETICS. 

Diaphoretics — or siidorifics, as they are also called — are medi- 
cines which promote diaphoresis or sweating. Their action in 
stimulating transpiration by the skin may be enhanced by exer- 
cise, external warmth, nauseants, and drugs which dilate the vessels, 
determining more blood to the cutaneous blood-vessels. 

Diaphoretics are employed principally for their evacuant, revul- 
sive, and alterative effects, and to promote absorption. 

Pilocarpus— Pilocarpi— Pilocarpus. JJ, S. P. 

(Jaborandi.) 

Orig-in. — The leaflets of Pilocarpus selloantts Engler (Rio Janeiro 
Jaborandi) and oi Pilocarpus Jaborandi Holmes (Pernambuco Jabo- 
randi). 

Description and Properties. — About 4 to 6 inches (10-15 Cm.) 
long and \ to 2\ inches (4-6 Cm.) broad, short-stalked, oval or 
ovate-oblong, entire and slightly revolute at the margin, obtuse 
and slightly emarginate, unequal at the base ; dull-green, coriace- 
ous, pellucid punctate, mostly smooth ; when bruised, sHghtly 
aromatic; taste somewhat bitter and pungent. 

Pilocarpus contains a volatile oil and two alkaloids, pilocarpine 
and jaborine, the latter being chemically isomeric with the former, 
although directly antagonistic in physiological action. 

Dose. — 5-60 grains (0.3-4.0 Gm.). 

Official Preparation. 

ExtrSctum Pilocarpi Fluidum — Extracti Pilocarpi Fluidi — Fluid Extract 
of Pilocarpus. — Z)(?j<?, 5-60 minims (0.3-4.0 Co.). . 

Unofficial Preparatiojt. 

Infusum Pilocarpi — Infusi Pilocarpi — Infusion of Pilocarpus. — Dose, 2 fluid- 
drachms-4 fluidounces (8.0-118,3 Cc). 

PilocarpTnae Hydrochl5ras— Pilocarpinae Hydro- 
cinloratis— Pilocarpine Hydrochlorate. U.S. P. 

Origin. — The hydrochlorate of an alkaloid obtained from Pilo- 
carpus. 

Description and Properties. — Small, white crystals, odorless 
and of a faintly bitter taste ; dehquescent on exposure to damp air. 



DIAPHORETICS. 595 

Very soluble in water and in alcohol. It should be kept in small, 
well-stoppered bottles. 

Dose. — ^^ - \ grain (0.OOI-0.03 Gm.). 

Jaborine is a yellow, amorphous alkaloid, isomeric with pilocarpine and closely 
resembling atropine in its physiological action. The varying effects which occasionally 
follow the use of the commercial pilocarpine are due to the presence of jaborine, which 
antagonizes the action of pilocarpine in almost every particular. 

It is highly important, therefore, when administering pilocarpine or any of its prep- 
arations to obtain the drugs free from jaborine, which is not used medicinally. 

Antagonists and Incompatibles. — Atropine is a perfect physi- 
ological antagonist to pilocarpine, being directly opposite in its 
action throughout its entire range, j^ grain (0.0006 Gm.) being 
sufficient to counteract \ grain (o.Oi Gm.) of pilocarpine. Morphine 
relieves the nausea. 

The incompatibles are tannic acid, caustic alkalies, and the ferric 
and metaUic salts. 

Synergists. — The cardiac depressants, particularly aconite and 
veratrum viride, gelsemium, sarsaparilla, spirit of nitrous ether, and 
drugs which paralyze the vaso-motor system, enhance the activity 
'of pilocarpus. 

Physiological Action. — Externally and Locally. — There is no 
action of importance. 

Internally. — Digestive System. — The action of pilocarpine is here 
given, since the alkaloid fully represents the drug. 

When pilocarpine is taken into the mouth, the ends of the 
chorda tympani and secretory nerves are stimulated, causing an 
increased secretion of saliva. Should large doses be taken, there 
is a feeling of tenderness in the mouth and severe salivation is 
produced. 

The gastric glands are stimulated by the drug, their normal 
secretion being augmented. By stimulating the unstriped muscle- 
fibers pilocarpine increases peristalsis, both of the stomach and the 
intestines, in large doses acting as a cathartic. Immoderate amounts 
may also induce vomiting. The bile and pancreatic juice are not 
affected by moderate amounts of the drug. 

Circnlatory System. — At first the vaso-motor nervous system is 
depressed, resulting in an acceleration of the cardiac movements, 
with dilatation of the blood-vessels. The heart, however, is soon 
slowed and the arterial pressure lowered, so that pilocarpine is in 
reality a cardiac depressant rather than a cardiac stimulant. 

Pilocarpine acts directly upon the heart, either by stimulating 



50 A TEXT-BOOK OF MATERIA MEDIC A. 

the terminations of the vagus or by depressing the motor centers 
in the heart-muscle or the muscle itself. 

Nervous System. — In medicinal amounts pilocarpine has no per- 
ceptible action on the central nervous system, although stimulating 
the nerve-terminations of involuntary muscles — i. e. those of the 
stomachy intestines, heart, spleen, bladder, uterus, etc. 

Poisonous doses have produced (in the frog) tetanic convulsions, 
followed by paralysis, the result of depression of the muscles and 
spinal centers, the nerves apparently being unaffected. 

Respiratory System. — ^The respiratory movements are unaffected 
by medicinal amounts, but the bronchial secretion is augmented. 

Absorption a7td Elimination. — Pilocarpine is rapidly absorbed, 
and is eliminated principally by the skin, occasioning free, and 
under large doses excessive, diaphoresis. 

The sweat is at first acid, then neutral, and finally alkaline in 
reaction. The diaphoresis produced by pilocarpine is due to stimu- 
lation of the secretory nerves supplying the glands. 

The kidneys, under small doses, are stimulated, there being a 
slight increase in the urine, while in disease the amount of urea is 
considerably augmented. 

The drug is also eliminated by the salivary glands, there being 
frequently an enormous increase in the salivary secretion. Under 
the influence of pilocarpine there is an increase in the gastric, 
bronchial, and lacrymal secretions, even the secretion of milk being 
notably augmented. 

Temperature. — Succeeding a very brief and slight elevation of 
temperature there is a decided diminution of bodily heat, resulting 
from the dilatation of cutaneous blood-vessels and the evaporation 
of the perspiration. 

Eye. — Whether applied locally to the eye or taken internally, 
pilocarpine produces marked contraction of the pupil by stimulating 
the peripheral endings of the iridal nerves. The drug also pro- 
duces an increased tension of the eyeball. 

Uter?cs. — There is authority for the statement that pilocarpine 
stimulates the gravid uterus, inducing uterine contractions or in- 
creasing the energy of those already established. 

The effect of the drug upon the uterus, however, is more pro- 
nounced and apparent in cases of eclampsia, seeming to prove the 
fallacy of the statement that pilocarpine is a true ecbolic. 

Untoward Action. — Nausea and vomiting are of quite frequent 
occurrence, the vomiting being preceded by long and distressing 



DIAPHORETICS. 597 

nausea. Occasionally the patient complains of severe pain in the 
urethra and in the lumbar region, with frequent desire to micturate. 

There have often been present headache, vertigo, hiccough, 
dimness of vision, gastric and abdominal pains, stupor, and chilli- 
ness. There may occur even collapse. 

Poisoning. — The symptoms produced by poisonous doses of 
pilocarpine are exaggerations of those described above, together 
with diarrhea, exhausting and excessive sweating and salivation, 
marked cardiac and respiratory depression, and collapse. 

Treatment of Poisoning. — If the drug has been ingested, the stom- 
ach should be immediately cleansed with a solution of tannic acid. 

To counteract the untoward effects of pilocarpine, whether the 
drug has been ingested or given by subcutaneous injection, atro- 
pine is undoubtedly the most complete physiological antagonist, 
and should be given hypodermically. Morphine is indicated to 
control the nausea and vomiting, while some of the cardiac stimu- 
lants may be required to counteract cardiac depression. 

Therapeutics. — Externally and Locally. — Pilocarpine, or the 
FLUID EXTRACT OF JABORANDI, has been highly recommended for 
alopecia. By the use of pilocarpine the hair becomes darker. The 
FLUID EXTRACT OF PILOCARPUS has been employed as a local appli- 
cation in erysipelas and eczema. 

Lozenges containing ^ grain (cooi Gm.) of pilocarpine are 
efficient in relieving dryness of the throat. As a myotic pilocarpine 
is used in many diseases of the eye. 

Inteimally. — The principal internal use of pilocarpine is as a 
diaphoretic in Brighfs disease. In cardiac dropsy it is not a safe 
remedy, because of its depressing influence upon the heart. 

The drug is very efficient in removing pleuritic effusion, while in 
uremic poisoning it is unquestionably the most valuable remedy we 
possess. 

The hypodermic injection of small doses of pilocarpine has 
been highly recommended as an efficient remedy in erysipelas, 
particularly during the first stages of the disease. 

The drug has been successfully used to abort malarial paroxysm, 
and has proved beneficial in tobacco and alcoholic amblyopia. 

Pilocarpine has been found useful in humid asthma, bi'onchor- 
rhea, and hiccough, and, in small doses, in arresting the sweating of 
phthisis and for the relief of ptyalism. The drug is an efficient 
galactogogue, and has been used with success in mumps, chronic en- 
largement of the cervical glands, and adenitis of the ingidnal glands. 



598 A TEXT-BOOK OF MATERIA MEDICA. 

Pilocarpine materially lessens the flow of urine in diabetes in- 
sipidiis, and in many diseases of the eye and ear the internal use of 
the drug serves a useful purpose. 

The property possessed by pilocarpine of stimulating the glands 
of the skin renders this remedy of great service in many cJironic 
diseases of the skin characterized by a dry, scaly condition. It is a 
peculiarly valuable agent in pJitliiriasis^ psoridsis, certain forms of 
eczema, pruritiLS senilis, etc. Pilocarpine or fluid extract of 
jABORANDi may be useful in breaking up a cold. 

Finally, pilocarpine has been highly recommended in catan'hal 
jaundice, and is one of the most efficient antidotes to belladonna- 
poisoning. 

Contraindications. — The drug should never be employed when 
the heart is weak from thinning and atrophy of its walls or from fatty 
degeneration, nor where there is a tendency to pulmonary conges- 
tion and edema. The drug is also contraindicated in asthenic 
fevers, such as typhoid fever, etc. 

Administration. — Pilocarpine is superior to the crude drug, 
being far more rehable in its action and less liable to produce 
nausea and vomiting. Pilocarpine is usually given hypodermically, 
although it is frequently administered by the mouth, in solution, or 
in troches. 

Of all the preparations of the crude drug, the fluid extract and 
infusion are commonly employed, the latter being less apt to cause 
profuse salivation. An elixir of pilocarpus is prescribed consider- 
ably. 

Should preparations of jaborandi be given upon an empty 
stomach, they are less apt to occasion nausea. This inconvenience 
may be also avoided by giving an infusion by enema. 

Liquor Ammonii Acetatis— Liqu5ris Ammonii Ace- 
tatis— Solution of Ammonium Acetate. V. S,JP. 

(Spirit of Mindererus.) 

Origin. — An aqueous solution of Ammonium Acetate, contain- 
ing about 7 per cent, of the salt, together with small amounts of 
Acetic and Carbonic Acids. 

Description and Properties. — A clear, colorless liquid free 
from empyreuma, of a mildly saHne, acidulous taste and an acid 
reaction. This preparation when required should be freshly made. 

Dose. — J-i fluidounce (15.0-30.0 Cc), in sweetened water. 



DIAPHORETICS. 599 

Official Preparation. 

Liquor F6rri et Ammonii Acetatis — Liquoris FSrri et Ammonii Acetatis — 
Solution of Iron and Ammonium Acetate (Basham's Mixture). — Described 
under " Preparations of Iron."' 

Antagonists and Incompatibles. — The metallic sulphates, the 
salts of lead and silver, lime water, the carbonates of potassium 
and sodium, and acids are incompatible. 

Synergists. — Spirit of nitrous ether, potassium citrate, and 
many of the refrigerants and diaphoretics. 

Physiolog'ical Action and Therapeutics. — Solution of am- 
monium acetate is both a mild diaphoretic and diuretic, according 
as the action is governed by other more powerful agents. For 
instance, if the skin is warm and the cutaneous blood-vessels 
dilated, the preparation acts as a diaphoretic, while if the condition 
of the skin is the reverse, the action of the drug is directed to the 
kidneys. Should the preparation be given with aconite or spirit 
of nitrous ether, its action would be that of a diaphoretic, but if 
the drug were associated with digitalis or squill, it would act as a 
diuretic. In any case the action of the drug is due to a stimulation 
of the secretory cells or nerves. 

The principal medical use of solution of ammonium acetate is 
as a diaphoretic in febrile conditions, such as acute coryza, influenza, 
acute pharyngitis, etc. It is a very efficient remedy in muscular 
rheumatism, and in the eruptive fevers when the eruption is re- 
tarded. It is frequently associated with other remedies in the 
treatment of scarlatinous dropsy. 

Owing to its property of stimulating the heart and circulation, 
the remedy has been recommended in low forms of fever, in the 
belief that it helps to sustain the powers of life, in lowering the 
pulse and temperature, moistening the tongue, and quieting the 
delirium. 

In migraine and in alcoholic intoxication few remedies are so 
successful, the drug frequently dissipating the effects of acute 
alcoholism at once. 

The remedy has been found efficacious in dysmenorrhea and 
mcnorrhagia, and has been employed externally and locally as a 
discutient in mammary engorgements, glandidar swellings, contu- 
sions, iitcipient abscesses, etc. 

Administration. — The preparation, as has been said, should be 
freshly made when wanted, and should be administered well diluted 
with sweetened water. 



600 A TEXT-BOOK OF MATERIA MEDIC A. 

SpTritus y^theris Nitrosi— Spiritus y^theris Nitrosi 
-Spirit of Nitrous Ether. JJ. S. r. 

(Sweet Spirit of Nitre.) 

Origin. — An alcoholic solution of Ethyl Nitrite, yielding, when 
freshly prepared and tested in a nitrometer, not less than eleven 
times its own volume of nitrogen dioxide. 

Description and Properties. — A clear, mobile, volatile, and 
inflammable liquid, of a pale-yellowish or faintly greenish-yellow 
tint, having a fragrant, ethereal, and pungent odor free from acridity, 
and a sharp, burning taste. It should be kept in dark amber-col- 
ored, well-stoppered bottles, remote from lights and fire. 

Dose. — J-2 fluidrachms (2.0-8.0 Cc). 

Antagonists and Incompatibles. — The incompatibles are po- 
tassium iodide, ferric sulphate, antipyrine, mucilage of acacia, tinc- 
ture of guaiacum, and gallic and tannic acids. 

Synergists. — Diaphoretics, diuretics, antispasmodics, tincture 
of aconite, potassium citrate, etc. 

Physiological Action and Therapeutics. — When applied to 
the skin and allowed to evaporate spirit of nitrous ether produces 
a slight anesthetic effect. Internally, its action is very similar to 
that of the ammonium acetate. It dilates the blood-vessels more 
than the latter preparation, besides being more of a diffusible stim- 
ulant, stomachic, and carminative. 

Like the solution of ammonium acetate, spirit of nitrous ether 
acts either as a diaphoretic or diuretic, the effect depending upon 
the manner in which it is administered. For its diuretic action it 
should be given in ice-water and the patient kept cool ; to produce 
diaphoresis its administration should be accompanied by warm 
drinks and the patient be well covered. 

Spirit of nitrous ether is used for about the same purposes as 
the solution of ammonium acetate, being particularly serviceable in 
febrile affections to promote critical sweating, employed either alone 
or in combination with tincture of aconite. It is frequently given 
as a diuretic in B right's disease, congestion of the kidneys, and pain- 
ful affections of the urinary apparatus. 

It is a serviceable remedy to relieve flatident distention of the 
stomach, to allay nausea, and to quiet nervous agitation. As an 
antispasmodic the remedy is frequently employed to relieve the 
pain of dysmenorrhea, and it may be inhaled for the relief of cough- 
ing. It enters into many expectorant mixtures, and is a soothing 
application to the forehead in neuralgic headache. 



EMETICS. 60 1 

Administration. — The dose and manner of administering spirit 
of nitrous ether depend upon the action desired. As an anti- 
pyretic in febrile affections it should be given in doses of 20-30 
minims (1.30—2.0 Cc), in sweetened water, every half hour. To 
produce diuresis the drug should be associated with some other 
diuretic and given in larger doses, J-i fluidrachm (2.0-4.0 Cc), 
every three or four hours. If the remedy is desired for its diapho- 
retic action, it should be given in hot water, in doses of 20 or 30 
minims (1.30-2.0 Cc), repeated every half hour, the patient being 
well covered. 

Should the drug be given as a nervous stimulant, the dose 
should not be less than i fluidrachm (4.0 Cc). 

Care should be exercised in the selection of spirit of nitrous 
ether that it be reliable and of full strength. If the preparation 
has been kept in large bottles exposed to light and air, the drug 
will be more or less inert and should not be prescribed. 



GROUP XL— EMETICS. 

Emetics are agents which produce vomiting or emesis. 

Vomiting is the result of the following actions : i. The relaxa- 
tion of the cardia; 2. The contraction of the pylorus ; 3. The con- 
traction of the gastric muscles ; 4. The contraction of the dia- 
phragm ; 5. The contraction of the abdominal muscles. The effect 
of these coordinate acts is to compress the stomach, expelling its 
contents through the relaxed cardia. 

The nervous mechanism involved in the act of vomiting is 
under the control of the medulla. The vomiting center may be 
stimulated in various ways — reflexly, through the sense of sight 
or taste, the stomach, peritoneum, biliar}^ passages, kidneys, heart, 
or lungs, or by irritation of the pharynx or esophagus. The dia- 
gram (Fig. 14) serves to explain the mechanism of emesis. 

This is the nervous mechanism directly involved in the act of 
vomiting, regardless of the cause of the emesis. The vomiting 
center and a portion of the respiratory center intimately connected 
with it act simultaneously, either by way of the stomach or reflexly 
through other parts of the body — as is illustrated in certain injuries 
or diseases — or by direct stimulation of the center by some sub- 
stance carried to it in the blood. 



6o2 



A TEXT-BOOK OF MATERIA MEDICA. 




Fig. 14. — A,A, abdominal walls ; B, respiratory muscle : i, respiratory center ; 2, vomiting center; 
3, stomach ; 4, afferent nerve passing from mucous membrane in stomach to vomiting center in me- 
dulla ; 5, efferent nerve passing from vomiting center to muscular fiber of cardia, relaxing it ; 6, efferent 
nerve passing from medulla to pylorus, contractmg it ; 7, efferent nerve, influencing gastric muscles tO' 
contract; 8, efferent nerve, causing contraction of diaphragm; 9, efferent nerve, causing abdominal 
muscles to contract. 



* Alum ; 

* Copper Sulphate ; 



The Local or Gastric Emetics^ are — 

* Yellow Mercuric Sulphate ; 

* Sodium Chloride ; 

* Zinc Sulphate ; * Ammonium Carbonate ; 

* Mustard. 

(The drugs marked with an asterisk (*) are considered elsewhere in the present 
work. ) 

The Direct or Systemic Emetics are — 
Apomorphine Hydrochlorate ; 
Antimony and Potassium Tartrate ; 
Ipecacuanha ; 
Lobelia. 

Local or gastric emetics are the more rapid in their action, 
producing emesis in from two to five minutes. The systemic 
emetics must be absorbed and pass to the medulla before they 
produce vomiting, consequently requiring more time to exert their 

^ Some authors reverse the nomenclature, considering those drugs which act only 
on the stomach "direct," and those affecting the medulla "indirect." 



EMETICS. 6C3 

influence. Moreover, the action of the latter class of emetics is 
of much longer duration and followed by greater depression of 
the muscular and circulatory systems, together with greater consti- 
tutional disturbance. 

Some emetics act both locally and centrally. Tartar emetic 
and ipecacuanha affect the stomach locally, but, since their action 
is chiefly upon the vomiting center through the circulation, they 
are classed as systemic emetics. Zinc sulphate and copper sul- 
phate, on the other hand, while to a slight extent acting on the 
medulla, are classed as local emetics, because their principal action 
is upon the mucous membrane of the stomach. 

Within a few minutes after an emetic has been ingested there is 
a feeling of nausea and distress, with decided muscular relaxation. 
The circulatory system is depressed ; the pulse is small and irregu- 
lar, and a sensation of faintness ensues. The flow of saliva is 
increased, and vomiting soon follows. During emesis the arterial 
tension is raised, the face is flushed, and there is an increase in 
bodily heat. When vomiting has subsided there is a reduction of 
temperature, with cardiac and muscular weakness, the skin being 
bathed in perspiration. Occasionally fatal syncope has followed 
the use of emetics. 



Antagonists. — Drugs known as Anti-emetics are used to allay 
nausea and check vomiting. Like emetics, these agents are divided 
into Local Anti-emetics or Gastric Sedatives and Direct or Sys- 
temic Anti-emetics, according to their action. 

Among the most important Anti-emetics are the following : 

Local Anti-emetics or Gastric Sedatives. 

(All save Ice are treated elsewhere in the present work.) 

Alcohol (especially champagne) ; Ether ; 

Arsenic (small doses) ; Ipecac (small doses) ; 

Belladonna; Ice; 

Bismuth subnitrate and subcar- Opium ; 

bonate ; Hydrocyanic acid ; 

Carbolic acid ; Menthol ; 

Cerium oxalate; Potassium nitrate; 

Chloroform ; Silver nitrate ; 

Cocaine ; Sulphocarbolates ; 

Creasote; Tincture of iodine (small doses). 
Calomel (small doses) ; 



604 A TEXT- BOOK OF MATERIA MEDIC A. 

Direct or Systemic Anti-emetics or Gastric Sedatives. 

Alcohol ; Chloral ; 

Ammonium ; Hydrocyanic acid ; 

Amyl nitrite ; Nitroglycerin ; 

Bromides ; Opium. 

It will be observed that some drugs are both local and direct 
Anti-emetics. 

There are certain measures which may be adopted to allay 
nausea and relieve vomiting, such as a recumbent posture and 
injection of large quantities of aerated water into the rectum. 

Synergists. — The emetics are of course mutually synergistic. 
Emetics are adjuncts to antiperiodics and expectorants, although 
the latter do not particularly enhance the action of the former. 

Emetics are used — 

1. To empty the stomach in cases where the presence of undi- 
gested food occasions pain, headache, etc., or to expel some poi- 
sonous substance from the stomach. For this purpose the local 
emetics are preferable. 

In cases of poisoning the local emetics are the more rehable. 

2. To reinove foreign bodies from the esophagus. For this pur- 
pose the dirett or systemic emetics should be used. 

3. To remove foreign bodies from the larynx, as in cases of 
membranous croup, laryngeal diphtheria, etc., the effort of vomit- 
ing being sometimes sufficient to dislodge and remove the mem- 
brane or other foreign substance. 

4. To remove the bronchial secretion in cases of bronchitis and 
catarrhal pneumonia. In these cases the direct emetics should be 
employed, preferably ipecacuanha or apomorphine, because they 
possess more expectorant properties. 

5. To empty the gall-bladder in cases of biliousness or malaria, 
or where small gall-stones are present in the gall-duct, the com- 
pression of the liver between the diaphragm and the abdominal 
muscles expelHng the bile from the liver into the duodenum and 
forcing the gall-stones through the duct. 

6. To relax spasm of the pharyngeal muscles in cases of spas- 
modic laryngitis. For this purpose the systemic emetics are pref- 
erable. 

Contraindications. — Emetics should not be given to persons 
suffering from aneurysm, hernia, peritonitis, prolapse of the uterus 
or rectum, atheroma, or where there is very high arterial tension, a 



EMETICS. 605 

tendency to hemorrhage from the lungs or uterus, or a tendency 
to abortion. 

The emetic drugs which have not been elsewhere discussed in 
the present work are here given in detail : 

Apomorphinae Hydrochloras— Apomorphlnae Hy- 
drochloratis — Apomorphine Hydrochlorate. 
V. S. J>. 

Origin. — The hydrochlorate of an artificial alkaloid prepared 
from Morphine or Codeine. 

Description and Properties. — Minute, grayish-white, shining, 
acicular crystals, without odor, having a faintly bitter taste, and 
acquiring a greenish tint upon exposure to light and air. Soluble 
in about 45 parts of water and about 45 parts of alcohol. It 
should be kept in small, dark, amber-colored vials. If the prepa- 
ration imparts to 100 parts of water when slightly shaken an 
emerald-green color, the drug should be rejected. 

Dose. — j-Q -^Q grain (0.003-0.006 Gm.) by the mouth ; -^5— g- 
grain (0.0025-0.01 Gm.) hypodermically. 

Physiological Action. — Externally and Locally. — None, 

Internally. — Digestive System.— Yxova five to twenty minutes 
after ingestion — according to the dose and the manner of adminis- 
tration — vomiting ensues, being repeated three or four times at 
intervals of about fifteen minutes. The emesis is preceded and 
attended by a slight nausea, with but moderate depression. Apo- 
morphine is a typical direct or systemic emetic, its entire action 
being exerted upon the vomiting center in the medulla. It is per- 
haps the most powerful and certain emetic we possess. 

Circulatory System. — Small doses have no perceptible effect upon 
the circulation. Full doses increase the rapidity and force of the 
heart's action and raise arterial pressure, owing to stimulation of the 
accelerator nerves and vaso-motor center. Large or toxic amounts 
depress the circulatory system or paralyze the cardiac muscle. 

Nervous System. — Full doses stimulate the brain and may even 
occasion delirium. Poisonous amounts produce convulsions, prob- 
ably of spinal origin, succeeded by paralysis of the motor and sen- 
sory nerves, and consequently of the muscles. 

Respiratory System. — Small amounts do not affect the respira- 
tory movements, although the secretion from the bronchial mucous 
membrane is increased. Full doses accelerate and deepen respira- 
tion, while toxic amounts cause depression. 



6o6 A TEXT-BOOK OF MATERIA MEDICA.- 

Absorption aiid Elunination. — Apomorphine is readily absorbed, 
and is excreted through the gastro-intestinal tract, as well as by the 
broncho-pulmonary mucous membrane, the kidneys, and the skin. 

Temperatm^e is unaffected by small doses, but may be lowered 
by large amounts. 

Poisoning. — The symptoms would be violent vomiting, delirium 
or convulsions, and marked cardiac and respiratory depression, 
death resulting from asphyxia. 

Treatment of Poisoning. — The systemic gastric sedatives and 
cardiac stimulants. 

Therapeutics. — Apomorphine is the most reliable emetic to use 
when prompt emesis is necessary or in cases where swallowing is 
difficult or impossible. 

It is extremely useful as an emetic in cases of poisonings though 
it frequently happens in narcotic poisoning that the vagus center is 
so blunted by the poison that apomorphine fails to act. 

Should it be necessary to provoke emesis when the stomach is 
in a state of acute inflammation, apomorphine is preferable to any 
other emetic. 

Given by the mouth in small doses — from -^-^ grain (o.ooi Gm.) 
to 2V g^ain (0.003 Gm.) every three or four hours — this drug is an 
exceedingly efficient remedy in acute bro?ichitis. It is equally 
beneficial in relieving the dry, hacking cough of chronic bronchitis^ 
chronic catarrhal pneumonia, and tuberculosis. 

Contraindications. — The same as for emetics generally. 

Administration. — Apomorphine when given as an emetic 
should invariably be administered hypodermically, and the solu- 
tion be always freshly prepared. When the drug is used as an 
expectorant it should be given by the mouth. Great care should 
be taken in administering the drug to children^ as they bear the 
remedy very badly. 

Antimonii et Potassii Tartras— Antimonii et Potas- 
sii Tartratis— Antimony and Potassium Tartrate. 
77. >S^. J>. 

(Tartar Emetic; Tartrated Antimonv.) 
Origin. — Antimony Trioxide is mixed with Acid Potassium 
Tartrate and Water to the consistence of a paste, allowed to stand 
for twenty-four hours, boiled in water, and crystallized. 

Description and Properties. — Colorless, transparent crystals 
of the rhombic system, becoming opaque and white on exposure 



EMETICS. 607 

to air, or a white, granular powder, without odor and having a 
sweet, afterward disagreeable, metallic taste. Soluble in 17 parts 
of water and in 3 parts of boiling water, but insoluble in alcohol, 
which precipitates it from its aqueous solution in the form of a 
crystalline powder. 

Dose. — As an emetic, 1-2 grains (0.06-0. 12 Gm.) ; as a cardiac 
depressant, \-\ grain (0.03-0.06 Gm.) ; as a diaphoretic and 
expectorant, 2^o~4 gi'ain (0.003-0.01 Gm.). 

Official Preparations. 

Syrupus Scillae Compositus — Syrupi Scillae Compositi — Compound Syrup 
of Squills (Hive Syrup). — Formula: Fluid Extract of Squill, 80; Fluid Extract of 
Senega, 80; Antimony and Potassium Tartrate, 2; Sugar, 750; Precipitated Calcium 
Phosphate, 10; Water, to looo. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Vlnum Antimdnii — Vini Antimonii — Wine of Antimony. — Formula: Anti- 
mony and Potassium Tartrate, 4; Boiling Distilled Water, 65; Alcohol, 150; White 
Wine, to 1 000. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Antag-onists and Incompatibles. — Opium, alcohol, and the 
cardiac stimulants and antispasmodics generally are antagonistic. 
Tannic and gallic acids and the lead salts are incompatible. 

Synergists. — Emetics, cathartics, and cardiac depressants pro- 
mote the action of tartar emetic. 

Physiological Action. — Externally and Locally. — Tartar emetic 
is a powerful irritant when applied to the skin, producing a fol- 
licular inflammation followed by a papular eruption, becoming 
vesicular, and later forming pustules with a central umbilication, 
desiccation finally occurring, the pustules closely resembling those 
of small-pox. 

Internally. — Digestive System. — Upon the mucous membrane of 
the gastro-intestinal tract, as upon the skin, antimony and potas- 
sium tartrate acts as a powerful irritant. Small doses, occasioning 
only a sensation of warmth in the stomach, soon produce an in- 
creased secretion of saliva and gastric juice, as well as of secretions 
from the intestines, liver, and pancreas, more or less nausea fre- 
quently accompanying these symptoms. 

A little larger dosage excites vomiting, due at first to the irri- 
tating action of the drug upon the mucous membrane and nerves 
of the stomach, and, as soon as the drug is absorbed, affecting 
directly the vomiting center in the medulla. Full or large doses 
irritate the intestines, producing diarrhea, the discharges, if the dose 



6o8 A TEXT-BOOK OF MA TERIA MEDICA. 

has been excessive, strikingly resembling those of cholera. Ac- 
companying the foregoing symptoms are severe cramps and 
epigastric pain. 

Circulatory System. — Tartar emetic is a powerful cardiac de- 
pressant, even in small doses slowing and weakening the heart's 
action, and simultaneously lowering arterial pressure by direct de- 
pression of the heart-muscle and of the vaso-motor mechanism in 
the walls of the blood-vessels. 

Poisonous doses of the drug profoundly depress the heart, 
which is finally arrested in diastole. 

Nervous System. — Antimony and potassium tartrate in small 
doses and under certain conditions exerts a sedative influence upon 
the brain. Indeed, its action is that of a depressant to the entire 
nervous system, particularly the spinal cord, small doses depressing 
the sensory side, while poisonous doses paralyze both the motor 
and sensory centers of the cord. 

Under the administration of antimony, therefore, reflex excita- 
bility is diminished and the muscular system is depressed, the drug 
acting as an antispasmodic, probably by its influence both upon the 
muscles and the nervous system. 

Respiratory System. — Very small doses have no effect upon 
the respiratory movements, but increase the secretions from the 
bronchial mucous membrane. Full doses depress the respiratory 
movements, shortening the inspiration, but prolonging expiration. 
Toxic doses render the breathing extremely irregular and greatly 
lengthen the pause between inspiration and expiration, while there 
is an enormous increase in the bronchial secretion. 

The action of tartar emetic upon the respiratory system is very 
complex. The explanation as given by Hare is : '' Primarily the 
respiratory center in the medulla is depressed, and the governing 
nerves of breathing, the pneumogastrics, are also rendered inactive ; 
secondarily, the cardiac failure readily causes pulmonary conges- 
tion ; and, thirdly, the drug causes such an outpouring of liquid 
and mucus into the bronchial tubes that the patient is drowned in 
his own secretion, which he is too weak to expel." 

Absorption and Elimination. — Tartar emetic rapidly enters the 
blood, and is eliminated by many channels, principally by the 
bowels, but also by the bile, milk, sweat, and urine. The drug is 
an active diaphoretic, expectorant, and cholagogue. 

Temperature. — Small doses do not affect temperature percep- 
tibly ; large doses lower bodily heat, chiefly by depressing the 



EMETICS. 609 

circulation, although the drug may possibly influence the heat- 
center to some extent, lessening heat-production. 

Untozvard Action. — The untoward manifestations produced by 
medicinal amounts of tartar emetic in individuals having a marked 
susceptibility to the drug do not differ essentially from the symp- 
toms of poisoning next described. 

Poisoning. — Tartar emetic produces all the symptoms of an 
irritant poison — severe burning sensation in the esophagus and 
stomach and violent and repeated vomiting, the ejecta, in addition 
to undigested food, containing mucus, bile, and frequently blood. 

These symptoms are attended with severe colicky pains in the 
abdomen and serous purging, the discharges resembhng those of 
cholera, the analogy with the latter disease being rendered the 
more striking by the presence of cramps in the extremities — a cha- 
racteristic feature of poisoning by tartar emetic. 

Together with these gastro-intestinal symptoms there is extreme 
prostration, accompanied by an irregular, weak, almost impercep- 
tible pulse, great muscular relaxation, depressed respiration, pinched 
and livid countenance, cold, clammy skin, reduction of tempera- 
ture, and scanty and bloody urine. Death may be preceded by 
stupor, wild dehrium, or convulsions. 

Treatment of Poisoning. — If the poison has not been entirely 
ejected in the act of vomiting, the stomach should be immediately 
washed out with a solution of tannic acid, after which strong coffee 
should be administered, together with demulcent drinks, anodynes, 
and respiratory and cardiac stimulants should they be necessary. 

Therapeutics. — Externally and Locally. — Tartar emetic was 
formerly used as a rubefacient, being still so employed to some 
extent. The tendency of the drug, however, to produce extensive 
papular eruption and destruction of tissue renders its external use 
unsafe. Hebra considers that the external use of tartar emetic is 
a " useless, injurious procedure, and occasionally even dangerous 
to life." 

S. Hartwell Chapman has recommended the use of a lozenge 
containing ^\-^ grain (0.0003 Gm.) of tartar emetic and -^-^ grain 
(0.00 1 Gm.) of codeine in acute inflammation of the throat when 
accompanied with fever. 

Internally. — The medical uses of tartar emetic are constantly 
becoming more restricted. Because of its slow and depressing 
action the employment of the drug as an emetic has been prac- 
tically abandoned. It is still used as a sedative antiphlogistic in 
39 



6lO A TEXT-BOOK OF MATERIA MEDICA. 

various acute inflmnmatioits. It is beneficial in the early stages of 
acute laryngitis and bronchitis, but its administration should be dis- 
continued after a free secretion of bronchial mucus is established. 

The remedy is occasionally given for its diaphoretic influence in 
Y3.nous fevers, and has even been recommended as a cholagogue. 

The COMPOUND SYRUP OF SQUILLS is a useful expectorant, being 
a popular and efficient remedy for crotip. 

Administration. — As an emetic the action of the drug is facili- 
tated and enhanced by associating it with ipecacuanha, the reme- 
dies together being given in powdered form. 

As a diaphoretic and expectorant small doses of the wine of 
antimony are preferable, repeated every two or three hours. 

Ipecacuanha— Ipecacuanhae— Ipecac. U, S, I*, 

Origin. — The root of Ceplia'elis Ipecacuanha (Brotero) A. Rich- 
ard, a plant indigenous in the damp forests of Brazil, New Granada, 
and the northeastern portion of Bolivia. It is cultivated to some 
extent in India and Sikkim. 

According to the National Dispensatory, " The drug first be- 
came known in Europe in 1672, and a few years after was success- 
fully employed by Helvetius, a Dutch physician living in Paris, 
from whom (1688) Louis XIV. purchased the secret for 1000 louis 
d'or and made it pubHc." 

Description and Properties. — The older roots are in pieces of 
2 to 6 inches (5-15 Cm.) in length and about \ inch (4 Mm.) thick, 
mostly simple, contorted, dull grayish-brown or blackish, finely 
wrinkled, closely and irregularly annulated and often transversely 
fissured ; bark thick, brittle, brownish, easily separated from the 
thin, whitish, tough, Hgneous portion ; odor slight, pecuHar, nau- 
seous ; taste bitterish, acrid, nauseating. When ipecac is sound 
and free from mouldiness its quality is proportionate to the thick- 
ness of the bark and the thinness of the ligneous portion. 

The active principle of ipecac is emetijie, of which there is present 
I to 2 per cent. The drug also contains ipecacuanhic or cephaelic 
acid, starch, resin, etc. 

Dose. — As an emetic, 15-30 grains (1.0-2.0 Gm.); as an expec- 
torant, |— 2 grains (0.03-0.12 Gm.). 

Official Preparations. 
Extractum Ipecacuanhae Fluidum — ExtrScti IpecacuSnhae Fluidi — Fluid 
Extract of Ipecacuanha. — Dose, as an emetic, 15-30 minims (0.2-0.5 Co.); as an 
expectorant, \-2 minims (0.03-0.12 Co.). 



EMETICS. 6ll 

Piilvis Ipecacu^nhae et Opii — Ptilveris Ipecacuanhae et Opii — Powder of 
Ipecac and Opium. (See Opium, p. 428.) 

Syrupus Ipecacu2nhae — Syrupi Ipecacu^nhse — Syrup of Ipecac. — Formula : 
Fluid Extract of Ipecac, 75; Acetic Acid, 10; Glycerin, 100; Sugar, 700; Water, to 
1000. — Dose, as an emetic, 2-6 fluidrachms (7,39-22.50 Cc.) ; as an expectorant, 5-30 
minims (0.3-2.0 Cc). 

Tinctura Ipecacu^nhae et Opii — Tincturse Ipecacuanhse et Opii — Tincture 
of Ipecac and Opium. (See Opium, p. 428.) 

Trochisci IpecacuSnhae — Trochiscos (ace.) Ipecacuanhas — Troches of Ipe- 
cac. — Composition: Each troche contains about \ grain (0.02 Gm.) of Ipecac, together 
with Tragacanth, Sugar, and Oil of Orange. 

Dose. — I to 6 troches. 

Trochisci Morphinae et IpecacuSnhae — TrocMscos (ace.) Morphinae et Ipe- 
cacu^nhse. (See Morphine, p. 429.) 

Vlnum Ipecacuanhas — VTni Ipecacuanhas — Wine of Ipecac (10 per cent.), — 
Dose, 1-60 minims (0.06-4.0 Cc), 



Antagonists and Incompatibles. — The gastric sedatives and 
narcotics generally hinder the emetic properties of ipecac. The in- 
compatibles are tannic acid and vegetable infusions containing it, 
metallic salts, and caustic alkalies. 

Synergists. — The emetics, sedative expectorants, warm drinks, 
are synergistic, and opium aids the diaphoretic properties of the 
drug. 

Physiological Action. — Externally and Locally. — Ipecac is a 
powerful irritant to the mucous membranes of the respiratory tract 
when the powdered drug is inhaled. The prolonged application 
of ipecac to the skin occasions much irritation, even producing 
vesication, pustulation, and ulceration. Ipecac also possesses some 
antiseptic properties. 

hiternally. — Digestive System. — In small doses ipecac acts as a 
stimulant to the stomach. The salivary and gastric glands are 
stimulated, the action of very small doses of the drug resembling 
that of vegetable bitters. 

Large doses are powerfully irritant and emetic, the emesis being 
the result of both a local irritation upon the stomach and a direct 
action upon the vomiting center in the medulla. The vomiting is 
preceded by and attended with but little if any nausea, although 
there is usually a marked increase in the secretion of bile and intes- 
tinal mucus, full doses of the drug acting not only as an emetic, 
but as a purgative and cholagogue. 

Circulatory System. — Except in occasioning the ordinary depres- 
sion incident to the act of vomiting, ipecac in moderate amounts 
has no influence upon the heart. Enormous doses, however, par- 



6i2 A TEXT-BOOK OF MATERIA MEDICA. 

ticularly if injected into the jugular vein, have destroyed the Hfe 
of dogs by cardiac paralysis. 

Nervous System. — Save in stimulating that portion of the me- 
dulla oblongata which presides over the act of vomiting, and a 
sHght diminution of the reflex activity of the spinal cord, ipecac 
has no important action upon the nervous system. 

Respiratory System. — So far as the respiratory movements are 
concerned, they are unaffected by moderate doses of ipecac. The 
bronchial mucous membrane is stimulated, augmenting the se- 
cretion of bronchial mucus, and therefore reflexly stimulating 
coughing. 

Absorption and Elimination. — The active principle of ipecac is 
rapidly absorbed, being eliminated chiefly by the gastro-intestinal 
mucous membrane, although the other secretions share in the 
excretory process, the skin being especially affected by this drug, 
which acts as a mild diaphoretic. 

Temperature. — Under medicinal doses the temperature is un- 
changed. Poisonous doses reduce temperature. 

Untoward Action. — Rarely, in persons peculiarly susceptible to 
the drug, intense cutaneous irritation and conjunctival inflammation, 
accompanied by neuralgia of the face and scalp, have been produced. 
Even soiling the hand with a few drops of the tincture of ipecac has 
occasioned unfavorable results. The general untoward symptoms 
are those of poisoning. 

Poisoning. — There is violent vomiting and purging, the ejecta 
containing bile and frequently blood. Among the graver symp- 
toms are abdominal pain, marked cardiac depression, muscular 
weakness, and greatly diminished reflex irritability. The skin is 
cold and bathed in perspiration. 

Treatinent of Poisoning. — Tannic acid should be given as the 
chemical antidote. Opium, belladonna, and cardiac stimulants may 
be necessary. 

Therapeutics. — Externally and Locally. — Troches of ipecac 
and spray inhalations of wine of ipecac are used to allay the cough 
and expectoration in acute bronchitis and obstinate " winter cough!' 

Powdered ipecac has been successfully employed as a dressing 
in anthrax, the drug being capable of destroying the anthrax 
bacilli, although having no effect on the spores. 

Interiially. — Ipecac in proper doses is a very efficient emetic, 
and is frequently employed as such, particularly when it is desir- 
able through the act of vomiting to empty the air-passages, as in 



EMETICS. 613 

croup, bronchitis, tracheitis, and the early stages of diphtheria. The 
action of the drug is so tardy, however, that it is not the most de- 
sirable emetic to use when it is necessary to empty the stomach 
quickly, as in cases of poisoning. 

When the stomach contains a quantity of undigested food, 
causing pain, headache, etc., ipecac is a valuable emetic to empty 
the stomach, since the drug occasions no marked nausea or de- 
pression. 

Paradoxical as it may seem, minute doses of ipecac, such as I 
to 4 minims (0.06-0.2 Cc.) of the wine or ^ig- to J grain (0.006-0.01 
Gm.) of the powdered drug, act as an efficient gastric sedative 
and stomachic, frequently arresting vomiting when other drugs have 
failed. The statement, however, that minim doses of the wine of 
ipecac allay the nausea and vomiting of pregnancy is probably 
apocryphal. 

Ipecac in small doses is an excellent adjuvant to other chola- 
gogues to relieve the distress of hepatic dyspepsia. The drug is 
equally advantageous in atojiic dyspepsia, attended with flatulence, 
depression of spirits, etc. 

The notoriety and pecuniary profit which Helvetius secured in 
connection with ipecac — ox Radix antidysenterica,2.?> it was origi- 
nally named by its propagator — were due to its apparent specific 
action in dysentery. 

The drug is peculiarly efficient in dysenterj^ of a bihous type, 
acute dysentery other than bilious yielding less readily to the rem- 
edy. It is true that in these last-named cases ipecac and opium 
have been advantageously employed, though it is probable that the 
opium had the larger influence in modifying the course of the dis- 
ease. Whatever the form of dysenteric attack may be, ipecac is 
the more efficient the earHer it is administered. 

The drug, in order to exert any beneficial influence in bilious 
dysentery, must be given in large doses — 60 to 90 grains (3.88- 
5.83 Gm.) in a single dose or 20 grains (1.29 Gm.) every four hours. 
These doses of course will at first produce emesis, but the repeti- 
tion of them tends to establish a tolerance of the remedy, an early 
attainment of which is most desirable. 

Various methods have been employed to aid the stomach in 
retaining the drug, such as the administration of opium or other 
gastric sedative, a sinapism placed upon the epigastrium, etc. 

Ipecac has been highly recommended in infantile dian'hea. It 
has been successfully employed in hematemesis and uterine hemor- 



6l4 A TEXT-BOOK OF MATERIA MEDICA. 

rhage, it being customary in the former complaint to give at first 
an emetic dose, succeeded by smaller and nauseating amounts. 

Like other emetics, ipecac has proved efficient in expediting 
labor by relieving rigidity of the os uteri. 

The drug has been found beneficial in relieving he^noptysis, and 
it is of unquestioned value in many affections of the lungs and 
bronchial tubes. In pneumonia, particularly in the congestive and 
declining stages of the disease, it has proved serviceable. 

In bronchitis and phthisis, especially when the secretion is scanty, 
and in chronic broncJiitis with much cough and but a moderate 
amount of expectoration, ipecac is a valuable remedy. It has been 
found valuable in spasmodic asthma. 

Ipecac is an important adjuvant to quinine in the treatment of 
remittejit and intermittent fevers, the latter disease having been 
cured, it is claimed, by ipecac alone in doses of i or 2 grains 
(0.06-0.12 Gm.), given every three or four hours. 

Contraindications. — Ipecac is not permissible for patients suf- 
fering from aneurysm, hernia, prolapse of uterus or rectum, etc. 

Administration. — The drug is notoriously uncertain in its 
action, probably because of the variation in the percentage of eme- 
tine, the freshly powdered root being ordinarily more reliable. 

For purposes of emesis the freshly powdered root is preferable, 
to be taken with plenty of warm water. An infusion or decoction 
is frequently employed to produce emesis. 

As a diaphoretic the powder is also preferable, though in any 
case the fluid extract may be substituted for the powdered form. 
As an expectorant the syrup and wine are the preparations usually 
employed. 

Children are very tolerant of ipecac, the syrup being the prepa- 
ration usually given to them. 

Emetine, though not official, is an important remedy, and may 
be administered as an emetic in doses oi -^\.o \ grain (0.005-0.01 
Gm.), and in correspondingly small doses when a diaphoretic or 
expectorant action is desired. 

Lobelia— Lobeliae— Lobelia. Z7. H. P. 

(Indian Tobacco.) 

Origin. — The leaves and tops of Lobelia inflata L., collected 
after a portion of the capsules have become inflated. The plant 
is indigenous in the United States. 

Description and Properties. — As it appears in the market 



EMETICS. . 615 

lobelia consists of fragments of green leaves, stems, rather elon- 
gated dried flowers, and portions of the membranous capsules. 
The odor is very irritating, and the taste pungent and persistently 
acrid. The plant contains a yellowish acrid liquid alkaloid, lobeline^ 
besides lobelic acid, lobelacrin, resin, fixed oil, gum, etc. 
Dose. — i-io grains (0.065-0.6 Gm.). 

Official Preparations. 

Extractum Lobeliae Fluidum — ExtrScti Lobelias Fluidi — Fluid Extract of 
Lobelia. — Dose, i-io minims (o. 06-0.6 Cc), 

Tinctiira Lobeliae — Tinctiirae Lobeliae — Tincture of Lobelia (20 per cent.). 
— Dose, 8-15 minims (0.5-1.0 Co.). 

Antagonists and Incompatibles. — The effects of lobelia on the 
circulatory system are antagonized by the cardiac stimulants ; its 
influence on the nervous system is counteracted by strychnine and 
other motor excitants. The incompatibles are all caustic alkalies. 

Synergists. — The motor depressants and emetics enhance the 
effects of lobelia. 

Physiological Action. — Externally and Locally. — Although the 
drug is readily absorbed through the skin, there is no action of 
importance. 

Internally. — Digestive System. — Lobelia produces symptoms 
similar to those of ipecac, save that lobelia is more powerful, occa- 
sioning more distressing nausea and intense prostration. 

Circidatory System. — Lobelia is a powerful cardiac depressant, 
its action being due both to direct depression of the heart and 
paralysis of the vaso-motor centers. Under poisonous doses the 
heart stops in diastole. 

Nervous System. — Full doses depress the motor nerve-ganglia. 
Poisonous doses are necessary to affect the higher cerebral centers, 
when coma and convulsions are produced. The muscles and 
nerves themselves are unaffected by lobelia. 

Respiratory System. — The muscular coats of the bronchi are 
relaxed by the drug. The respiration is slowed even by small 
doses. Large or toxic doses profoundly depress the respiratory 
center, death resulting from respiratory failure. 

Absorption and Elimination. — The active principle of lobelia is 
readily absorbed, and is excreted chiefly by the kidneys and 
skin, the drug acting as a diuretic and diaphoretic. Under emetic 
doses much of the drug is ehminated by way of the stomach and 
intestines. 



6l6 A TEXT-BOOK OF MATERIA MEDICA. 

Temperature. — Full doses lower the temperature. 

Untoward Action. — Does not differ essentially from the effects 
of poisoning. 

Poisoning. — The symptoms include — violent vomiting and 
purging, a very weak and irregular pulse, an anxious, livid coun- 
tenance, skin cold and bathed in perspiration, respiration slow and 
very feeble, contracted pupils, and possibly coma or convulsions 
preceding death, which occurs from respiratory failure. 

Treatment of Poisoning. — The symptoms should be counter- 
acted by cardiac and respiratory stimulants, employing such drugs 
as atropine, strychnine, alcohol, ammonia, etc., hypodermically. 

Therapeutics. — Externally and Locally. — None. 

Internally. — While formerly lobelia was used extensively as an 
emetic, at the present day, owing to the intense nausea and great 
depression occasioned by the drug, it has been practically sup- 
planted by other less dangerous emetics. 

Its principal use nowadays is as a remedy in spasmodic asthma 
and as an expectorant in certain cases of bronchitis. 

Contraindications. — The same as for emetics in general. 

Administration. — The powder, fluid extract, or tincture may 
be used. The taste of the fluid preparations may be agreeably 
disguised by aromatic elixir or aromatic elixir of Hquorice. 



GROUP XII.— EXPECTORANTS. 

Expectorants are drugs which stimulate, depress, or modify 
the secretion from the bronchial or laryngeal membrane and pro- 
mote its expulsion. 

There are many drugs not classed as expectorants which, under 
certain conditions, may be used to serve one of these purposes. 
Thus, opium and chloral, by the depressing influence which they 
exert upon the respiratory center and the reflex mechanism, may 
relieve reflex and purposeless cough, or, as is the case with the 
former drug, check excessive secretion or render it more viscid. 

Demulcents, such as gum acacia, flaxseed, elm, etc., and other 
drugs like potassium chlorate, sodium chloride, etc., either lessen 
or excite the tracheal and bronchial cilia, retarding or promot- 
ing expectoration of bronchial mucus. The classification usually 
adopted seems to be the most reasonable — viz. that of dividing 
expectorants into two classes: i. Nauseant or Sedative. 2. Stim- 
ulating. 



EXPECTORANTS. 617 

Among the more important Nauseant or Sedative Expectorants 
are — 

* Alkalies ; * Ipecacuanha ; 

* Antimony and Potassium Tar- * Lobelia ; 

trate (Tartar Emetic) ; * Pilocarpus ; 

* Apomorphine ; * Potassium Iodide ; 

* Grindelia ; * Quebracho ; 
all of which are considered in detail elsewhere. 

The important Stimulating Expectorants are — 

* Acids ; Oil of Scotch Fir (Oleum Pini 
^Ammonium Carbonate; Sylvestris); 

Ammonium Chloride ; Oleum Pini Pumilionis ; 

^ Balsam of Peru ; Onion ; 

Balsam of Tolu ; Saccharine Substances ; 

* Benzoin and Benzoic Acid ; Senega (Saponin) ; 

* Copaiba ; * Sulphur ; 
'*' Cubeb ; * Squill ; 

Garlic; Tar; 

Liquorice; _ Terebene ; 

^ Nux Vomica Terpin Hydrate; 

(Strychnine) ; * Turpentine. 

(Those marked with an asterisk (*) are elsewhere given in detail.) 

As a rule, Sedative Expectorants are permissible only in acute 
stages of bronchitis, when, as is the case in the beginning of all in- 
flammations, there is complete or partial suspension of function, 
absence of secretion, and much irritation in the bronchi, with dis- 
tressing, harsh, and dry cough. 

In these conditions of the respiratory passages the nauseating 
sedative expectorants serve a useful purpose in lowering arterial 
tension, lessening the blood-supply to the inflamed parts, and 
increasing the secretion of mucus. 

In sufficiently large doses to produce emesis the same expecto- 
rants are frequently employed to expel an accumulation of mucus 
mechanically by the act of vomiting. 

Stimulating expectorants are more serviceable in chronic and 
relaxed conditions of the mucous membrane. They are usually 
employed to diminish or disinfect an abnormally increased secre- 
tion. These remedies generally increase blood-pressure and facili- 
tate expectoration, being eliminated to a great extent by the 
mucous membranes which they stimulate. 



6i8 A TEXT- BOOK OF MATERIA MEDIC A. 

The alkalies are especially useful in lessening the viscidity of 
mucus, rendering it more fluid, less tenacious, and therefore more 
easily expelled. 

It requires considerable skill to combine expectorants so as to 
best suit the various conditions found in practice. The diseases of 
the respiratory passages gradually merge, so that in the treatment 
of them it is often difficult to decide which remedy will be of more 
service, a sedative or a stimulant expectorant. The physician 
should carefully examine each individual case and decide whether 
he wishes to diminish or increase the blood-supply to the respira- 
tory tract ; to stimulate or depress the respirations ; to overcome 
spasm of the bronchial muscles ; to diminish, increase, or disinfect 
the bronchial secretion. 

A thorough knowledge of the patient's condition and of the 
physiological action of the various remedies at command will 
enable the observant practitioner to combine expectorants in such 
manner as to yield ordinarily highly satisfactory results. 

Ammonii Chloridum— Ammonii Chloridi— Ammo- 
nium Chloride. Z7. H, I". 

Orig-in. — Ammonium sulphate is first formed by neutralizing 
Gas Liquor with Sulphuric Acid. After crystallization sublime 
with Sodium Chloride. 

Description and Properties. — A white, crystalline powder, 
without odor, having a cooling, saline taste, and permanent in the 
air. Soluble in 3 parts of water ; almost insoluble in alcohol. 

Dose. — 1-30 grains (0.06-2.0 Gm.). • 

Official Preparation. 

Trochisci Ammonii Chloridi — Trochiscos (ace.) Ammonii Chloridi — 
Troches of Ammonium Chloride. — Each troche contains 2 grains (0.12 Gm.). — 
Dose, I to 6 troches. 

Antagonists and Incompatibles. — Therapeutically, ammonium 
chloride is antagonized by the cardiac depressants. The incom- 
patibles are — alkalies, alkaline earths and their carbonates, tartaric 
acid, mineral acids, and the soluble lead and silver salts. 

Synergists. — The expectorants, emetics, and diaphoretics en- 
hance the action of the drug. 

Physiological Action. — Externally and Locally. — Ammonium 
chloride is irritant and resolvent. 



EXPECTORANTS. 619 

Internally. — In medicinal doses the drug increases the secretions 
from the gastro-intestinal glands, acting as a cholagogue. The 
soHd constituents of the blood are diminished. The drug appears 
to have a special action upon the mucous membranes, augmenting 
their normal secretions and promoting nutritive changes and 
epithelial exfoliation. 

Ammonium chloride is readily absorbed, and is eliminated by 
the kidneys, skin, bronchi, and mucous membranes generally, the 
drug being a feeble diuretic, diaphoretic, and expectorant 

Save uric acid, which is slightly diminished, all the soHds of the 
urine are increased under the use of ammonium chloride. The 
drug is not considered poisonous. 

Therapeutics. — Externally and Locally. — Ammonium chloride 
possesses a wide range of therapeutic applications. Solutions of 
various strengths have proved markedly efficient as local applica- 
tions in indolent buboes, epididymitis, orchitis, bridses, inflammatory 
szvellings, suppurative mastitis, etc. Serdle gangrene is much bene- 
fited by immersing the foot in a bath containing 8 ounces (249.0 
Gm.) of the drug. 

A solution of 3 drachms (12.0 Gm.) of ammonium chloride to 
I pint (473.17 Cc.) of water is an efficient remedy in vaginitis. 
The lotion may be used as an injection or a tampon saturated with 
the fluid and applied to the parts. 

Lozenges, solutions, or the nascent fumes of the drug have 
been found serviceable in many diseases of the nose, tJiroat, and 
ear, such as coryza, chronic laryngitis diwd phaiyngitis, chronic anral 
catarrh, etc. 

Internally. — Few remedies are more efficient than ammonium 
CHLORIDE in bronchitis that has passed its inflammatory stage. In 
chronic bronchitis, particularly that form occurring in old people 
and persons of a feeble habit of body, the drug is very valuable, 
either given alone or associated with stimulant expectorants. The 
remedy has appeared to be somewhat beneficial in whooping cough. 

Ammonium chloride has been employed in intermittent feverd^wA 
to promote the eruption in the exanthematous fevers. It is certainly 
of great utility in goiter, and has proved beneficial in amenorrhea 
and dysmenorrhea. The drug is considered an efficient remedy in 
glandular enlargements, as in those of the prostate, liver, etc. It 
assuredly stimulates the functional activity of the liver and is fre- 
quently given as a cholagogue. 

Ammonium chloride usually exerts a prompt and salutary 



620 A TEXT-BOOK OF MATERIA MEDICA. 

action in neuralgias, particularly the neuralgia affecting the fifth 
pair, the intercostal nerves, and the sciatic nerve. The remedy has 
been also advantageously employed in myalgia and chronic mus- 
cular rheumatism. 

Contraindications. — Inflammation of the stomach, aggravated 
dyspepsia, marked emaciation, and anemia contraindicate the drug. 

Administration. — Ammonium chloride is best given in solution, 
its disagreeable taste being well disguised by the addition of some 
preparation of Hquorice, such as the syrup, fluid extract, or the 
aromatic elixir of liquorice. In bronchial diseases the virtues of 
the drug are enhanced by this association. 

Balsamunn Tolutanum— Balsam i Tolutani— Balsam 
of Tolu. V.S.^, 

Origin. — A balsam obtained from Toluifera Balsamum L., an 
evergreen tree from 60 to 80 feet (18-24 M-) high, growing in the 
high, rolling country of Venezuela and New Granada. 

Description and Properties. — A yellowish-brown, semi-fluid, 
or nearly soHd mass, becoming more brittle when exposed to cold ; 
transparent in thin layers, having an agreeable odor, recalling that 
of vanilla, but distinct from it, and a mild, aromatic taste ; readily 
and completely soluble in alcohol, chloroform, and solutions of the 
fixed alkalies ; almost wholly soluble in ether, but nearly insoluble 
in water or carbon disulphide. 

The drug contains a volatile oil (chiefly toluene), cinnamic and 
benzoic acids, and a resin. 

Dose. — 8-30 minims (0.5-2.0 Cc). 

Official Preparations. 

S5^rupus Tolutanus — Syrupi Tolutani— Syrup of Tolu (i per cent.). — Dose, 
2-6 fluidrachms (8-24 Cc). 

Tinctura Tolutana — Tincturae Tolutanae — Tincture of Tolu (10 per cent.). 
— Dose, ^-2 fluidrachms (2-8 Cc). 

Tinctura Benzoini Comp6sita — Tincturae Benzolni Compositae — Compound 
Tincture of Benzoin (4 per cent.). — Described under Benzoin. 

Antag-onists and Incompatibles. — Aqueous preparations are 
pharmaceutically incompatible with the tincture of tolu. 

Synergists. — The balsams, aromatic drugs, volatile oils, and 
stimulant expectorants. 

Physiological Action. — Balsam of tolu is antiseptic, disinfec- 
tant, and stimulant when applied to the skin and to raw surfaces. 
It is a pleasant carminative and stomachic. 



EXPECTORANTS. 621 

The drug is excreted principally by the mucous membranes, 
the secretions from which it stimulates and disinfects. The skin 
and kidneys also share in the excretory process. 

Therapeutics. — Inhalations of the vapor of tolu have been suc- 
cessfully employed in the treatment of chronic pharyngitis, and a 
pigment composed of i part of tolu to 5 parts of ether or alcohol 
has been beneficially appHed to diphtheritic deposits on the tonsils 
and pharynx. 

Its agreeable flavor, together with its stimulating and expector- 
ant properties, renders tolu an efficient and eligible ingredient of 
cough mixtures, lozenges, vapors, etc. employed to modify the 
course of subacute and chronic bronchitis. 

Administration. — Tolu is usually administered in the form of 
syrup, although the tincture may be given in emulsion. Inhala- 
tions of tolu vapor are employed and lozenges containing tolu are 
frequently used. 

Allium— Allii— Garlic. V. S. J>. 

Origin. — The bulb of Alliiun sativum L., a bulbous plant indig- 
enous in Central Asia and the basin of the Mediterranean, and 
cultivated for culinary purposes in Europe and North America. 

Description and Properties. — Bulb Fubglobular, compound, 
consisting of about eight compressed, wedge-shaped bulblets, 
arranged in a circle about the base of the stem and covered by 
several dry, membranaceous scales. Odor pungent and disagree- 
able ; taste warm and acrid. Garlic should be used without having 
been dried. 

The drug contains about \ per cent, of a volatile oil, to which 
its odor and taste are due. 

Dose, of bruised or chopped garlic or of the expressed juice, 
about 30 grains (2.0 Gm.). 

Official Preparation. 
Syrupus Allii— Syrupi Allii— Syrup of QiZxWz.—Dose, 1-2 fluidrachms (4.6- 
8.0 Cc). 

Allied Species. 
Allium Cepa L.— Allii Cepae— Onion. 

Physiological Action. — Both garlic and onion are stimulants 
to the part to which they are directly applied, garlic being the 
stronger of the two. 



622 A TEXT-BOOK OF MATERIA MEDICA. 

Internally they are carminative and stomachic, and are used as 
condiments and as foods. Like all substances which stimulate the 
digestive apparatus, in excessive amounts they may occasion nausea, 
vomiting, colic, and diarrhea. 

The active constituents of these drugs are eliminated by the 
mucous membranes, skin, kidneys, and respiratory tract. The 
taste and odor of the drugs are imparted to the milk of nursing 
women. Both garlic and onion are rapidly absorbed and about as 
quickly eliminated. 

Therapeutics. — An onion poultice is a valuable domestic rem- 
edy for chronic or acute bronchitis in children, abscesses, and to 
reheve strangury when applied to the perineum, in which case it 
proves to be singularly efficient. 

The core of a roasted onion is said to quickly relieve earache 
when inserted in the auditory canal. 

Syrup of garlic or onion is an invaluable expectorant in chronic 
catarrhs of the respiratory passages in children and infants, and is 
quite an efficient remedy in the decline of whooping cough. 

A synthetical substance known as Allyl Tribromide (Tribrom- 
hydrin), closely alhed to oil of garlic, has been highly recommended 
in spasmodic astJima, infantile convulsions, hysteria, angina pectoris, 
and other spasmodic disorders. It should be administered in cap- 
sules in doses of from i to 5 minims (0.06-0.3 Cc). 

Administration. — When garlic or onion is used for poultices, it 
should be boiled. 

Internally, the expressed juice made into a syrup with sugar or 
the official syrup of garlic is the form in which these drugs are 
usually given. 

Glycyrrhlza— Glycyrrhlzae— Glycyrrhiza. TJ, S. .P. 

(Liquorice Root.) 

Origin. — The root of Glycyrrhiza glabra L. and of the variety 
glandulifera (Waldstein et Killaibel) Regel et Herder, a perennial 
plant indigenous in the countries lying on the northern and south- 
ern shores of the Mediterranean and farther east through the Cau- 
casus, Northern Persia, Afghanistan, and Southern Siberia to China, 
and cultivated to some extent in England, France, Germany, and 
the United States. 

Description and Properties. — In long, cylindrical pieces from 
;^ to I inch (6-25 Mm.) thick, longitudinally wrinkled, externally 
grayish-brown, warty ; internally tawny yellow, pliable, tough ; 



EXPECTORANTS. ^"23 

fracture coarsely fibrous ; bark rather thick ; wood porous, but 
dense in the narrow wedges ; medullary rays linear ; taste sweet, 
somewhat acrid. The underground stem, which is often present, 
has the same appearance, but contains a thin pith. 

The drug derived from the variety glandulifera (so-called Rus- 
sian liquorice) consists usually of roots or root-branches I to 4 
inches (2-10 Cm.) thick and 8 to 12 inches (15-30 Cm.) long, fre- 
quently deprived of the corky layer, the wood rather soft and 
usually more or less cleft. 

Liquorice contains a glucoside, glycyrrhizm, besides asparagin, 
glycyramarin, an acrid resin, starch, etc. 

Dose. — 15-60 grains (1-4 Gm.). 

Official Preparations. 

Extractum Glycyrrhizae Fluidum — ExtrScti Glycyrrhizae Fluidi — Fluid 
Extract of Glycyrrhiza. — Dose, 15-60 minims (1.0-4.0 Cc). 

Extractum Glycyrrhizae — Extract! Glycyrrhizae — Extract of Glycyrrhiza. — 
Dose, freely. (Extract of Glycyrrhiza is contained in Trochisci Ammonii Chloridi and 
Trochisci Glycyrrhizae et Opii.) 

ExtrSctum Glycyrrhizae Piirum — ExtrScti Glycyrrhizae Piari — Pure Extract 
of Glycyrrhiza. — Dose, freely. 

Glycyrrhizinum Ammoniatum — Glycyrrhizini Ammoniati — Ammoniated 
Glycyrrhizin. — Description and Properties. — Dark-brown or brownish-red scales, with- 
out odor and having a very sweet taste ; readily soluble in water and in alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Mistura Glycyrrhizae Comp6sita — Misturae Glycyrrhizae Compositae — Com- 
pound Mixture of Glycyrrhiza (Brown Mixture). — Formula: Pure Extract of 
Glycyrrhiza, 30; Sugar, 50; Mucilage of Acacia, 100; Camphorated Tincture of Opium, 
120; Wine of Antimony, 60; Spirit of Nitrous Ether, 30; W'ater, to 1000. 

Dose. — 1-4 fluidrachms (4.0-15.0 Cc). 

Piilvis Glycyrrhizae Comp6situs — Ptilveris Glycyrrhizae Compositi — Com- 
pound Powder of Glycyrrhiza. (See Senna, p. 681.) 

Besides the foregoing compounds, glycyrrhiza forms a more or 
less important ingredient of eleven other official preparations. 

Physiolog-ical Action and Therapeutics. — The drug when 
chewed increases the flow of saliva. It is demulcent and laxative, 
and possesses slight stimulating properties when locally applied. 
It favors the secretions of the congested mucous membrane of the 
respiratory passages. 

Liquorice is used chiefly for its demulcent properties in sore 
throat, hoarseness, pharyngeal cough, acute bronchitis, etc. An in- 
fusion of the root is an agreeable and useful drink in febrile 
catarrhal affections and in irritative disorders of the bozvels and 
urinary organs attended with fever and great thirst. 



624 ^ TEXT-BOOK OF MA TERIA MEDICA. 

The various preparations of liquorice are serviceable in conceal- 
ing the taste of nauseous and bitter medicines and as an excipient 
for pills. 

Administration. — There are no special directions to be given — 
any of the preparations may be used. 

Oleum Pini SylvSstris — Olei Plni SylvSstris — Oil of Scotch Fir (unofficial). 
— Origin, Descripion, and Properties. — A volatile oil distilled from the leaves of Pinus 
Sylvestris, colorless, fragrant. Used by inhalation or locally. The drug is used in 
various sprays and inhalations in nasal catarrh, acute coryza, and many diseases of the 
respiratory passages. 

Oleum Templlnum — Olei Templini — Oil of Pine (unofficial). — Origin, Descrip- 
tion, and Properties. — A volatile oil distilled from the shoots of Pinus Pumilio. A col- 
orless or yellowish-green oil, of an agreeable, somewhat terebinthinate odor. 

Oleum Templinum is used in the same manner and for the same purposes as Oil of 
Scotch Fir. 

Pix Liquida— PTcis LTquidae— Tar. TJ> S. JP. 

Origin. — An empyreumatic oleoresin obtained by the destructive 
distillation of the wood of Pinus palustris Miller, and other species 
of Pinus. 

Description and Properties. — Thick, viscid, semi-fluid, black- 
ish-brown, heavier than water, transparent in thin layers, becoming 
granular and opaque with age ; odor empyreumatic, terebinthinate ; 
taste sharp, empyreumatic. Tar is slightly soluble in water ; solu- 
ble in alcohol, fixed and volatile oils, and solution of potassium or 
sodium hydrate. 

The drug contains many substances, chief among which are an 
empyreumatic, volatile oil, pyrocatechin, acetone, xylol, toluol^ 
cresols (creasote), guaiacol, phenol, etc. 

Dose. — 15-60 grains (1-4 Gm.). 

Official Preparations. 

Synipus Picis Liquidse — Syrupi Picis Liquidse — Syrup of Tar (7.5 percent.). 
— Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

UnguSntum Picis Oquidae — UnguSnti Picis Liquidae — Tar Ointment (50 
per cent.). — Used externally. 

Oleum Picis Liquidse— Olei Picis Liquidae — Oil of Tar. U. S. P. — Origin, 
— A volatile oil distilled from tar. 

Description and Properties. — An almost colorless liquid when freshly distilled, but 
soon acquiring a dark reddish-brown color and having a strong tarry odor and taste. It 
is readily soluble in alcohol. — Dose, 1-5 minims (0.065-0.3 Cc). 

Unofficial Preparatio?is. 
Aqua Picis Liquidae — Aquae Picis Liquidae — Tar Water. — Dose^ i pint 
(473.17 Cc.) in the course of a day. 



EXPECTORANTS. 625 

Glyceritum PIcis Liquidae — Glyceriti Picis Liquidae — Glycerite of Tar. — 

Dose, \-2, fluidrachms (2.0-8.0 Cc). 

Vinum Picis (N. F.) — Vini Picis — Wine of Tar (a saturated solution in sherry 
wine). — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Derivatives and Allied Drugs. 

Lysol. — Prepared by the action of alkahes on tar-oils and fats. A brownish, oily 
liquid with a feeble, aromatic creasote-like odor, containing 50 per cent, of cresols and 
readily miscible with water. Used as a disinfects nt and antiseptic. 

Pixol. — A compound of tar soap and caustic potash or soda. Used as a disinfec- 
tant and antiseptic. 

Pix B6tulae— Picis BStulae — Birch Tar (Oleum Rusci). — Origin. — Prepared 
in Russia from the wood and bark of Bdula alba L. 

Description and Proper-ties. — Resembling wood-tar in appearance, but remaining 
liquid, and having the pecuhar, penetrating odor of Russia leather, in the manufacture 
of which it is used. For the most part employed externally. 

Oleum Cadinum — Olei Cadini — Oil of Cade. U. S. P. — Origin. — A product 
of the dry distillation of the wood of yiaiiperus oxycedrus L. 

Description and Properties. — An empyreuraatic, brownish or dark-brown, clear, 
thick liquid, possessing a tarry odor and an empyreumatic, burning, somewhat bitter 
taste. Almost insoluble in water ; partially soluble in alcohol. 

Dose. — 2-6 minims (0.12-0.3 Cc). Chiefly used externally. 

Antagonists and Incompatibles. — There are none of special 
importance. 

Synergists.-~The aromatics, carbolic acid, creasote, and many 
of the antiseptics, turpentine, and the stimulant expectorants. 

Physiological Action. — Externally and Locally. — Tar is a stim- 
ulant, astringent, antipruritic, antiseptic, and parasiticide. It is readily 
absorbed from the skin, and when applied too freely may produce 
a papular eruption. 

Internally. — The action of tar closely resembles that of turpen- 
tine, although creasote is perhaps a more perfect analogue. Small 
doses stimulate the circulation and increase secretions generally. 
Immoderate dosage or the prolonged administration of tar impairs 
the appetite, deranges digestion, and depresses the circulatory and 
nervous systems. 

While the drug is not considered poisonous, the ingestion of 
excessive quantities of oil of tar has been attended with a few fatal 
results. The symptoms following imprudent dosage are nausea, 
vomiting, severe abdominal pain, diarrhea, headache, and dizziness. 
The urine is colored blackish-brown, and may contain blood or 
albumin and emit the peculiar odor of tar. There may be present 
erythema, or the skin may be covered with papules or vesicles 
attended with intense itching. 

Therapeutics. — Externally and Locally. — With the possible 

40 



626 A TEXT-BOOK OF MATERIA MEDICA. 

exception of sulphur and mercury, tar is the most universally 
employed remedy for cutaneous diseases, the drug having for cen- 
turies held an important place among the efficient topical agents 
in the treatment of diseases of the skin, unhealthy ulcers, fissured 
nipples, boils, excoriations, etc. 

In chronic eczema the drug is peculiarly serviceable, and it has 
proved beneficial in chronic psoriasis and scabies. 

The OIL OF CADE and oil of birch are used for the same pur- 
poses as tar, being usually preferred by expert dermatologists. 
The tarry preparations are valuable antipruritics, and of service in 
pruritus and various itching diseases of the skin, although their 
tendency to produce irritative and inflammatory effects when con- 
tinuously and injudiciously applied should not be overlooked. 

The benign and emollient effects of tar are best obtained when 
the drug is mixed with some soothing or astringent powder, such 
as chalk. 

The valuable properties of tar in the treatment of cutaneous 
diseases are often nullified by the ignorance of the physician and 
lack of proper administration of the drug. Prof James Nevins 
Hyde has truthfully observed that " the skill of a physician en- 
trusted with the management of a disease of the skin might also 
be measured by his success in the use of tar," 

Lozenges containing tar, the vapor of oil of tar, and sprays 
containing tar are extensively employed in the treatment of various 
diseases of the nose and throat. 

Internally .—T KK has long possessed an enviable reputation as a 
remedy for chronic pulmonary complaints, being very efficient in 
the treatment of chro7tic bronchitis and the advanced stages of 
obstinate acute bronchitis, lessening the expectoration, allaying 
the oppression and distress in the chest, and soothing the cough. 
These symptoms, which attend many cases of pulmonary phthisis, 
are frequently relieved by some preparation of tar. 

Not only is this remedy of value in catarrhal conditions of the 
respiratory passages : it is equally efficient in similar conditions of 
mucous membranes elsewhere. Thus tar water has been emplgyed 
with great benefit in gleet, leucorrhea^ vesical catarrh, etc., being 
given both by the mouth and in the form of an injection. 

Administration. — Tar may be given in milk or beer or in pill 
form, although the most palatable forms are the syrup, glycerite, 
wine, and tar water, the last of which may be given to the extent 
of I or 2 pints (473.17 or 946.35 Cc.) daily. 



EXPECTORANTS. 627 

Senega— Senegrae—Senegra. V. S. JP. 

Orig-in. — The root of Polygala Senega L., a plant indigenous in 
North America, from Canada southward to South CaroHna and 
westward to Wisconsin. 

Description and Properties. — About 4 inches (10 Cm.) long, 
with a knotty crown and spreading, tortuous branches, keeled 
when dry, fleshy and round after having been soaked in water ; 
externally yellowish-gray or brownish-yellow ; bark thick, white 
within, enclosing an irregular, porous, yellowish wood ; odor slight, 
unpleasant ; taste sweetish, afterward acrid. Senega contains sene- 
gin, also known as saponin, and polygalic acid, an acrid principle 
to which the medicinal property of the drug is due, besides a fixed 
and a volatile oil. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extractum SSnegae Fluidum— Extract! SSncgae Fluidi — Fluid Extract of 
Senega. — Dose., 10-30 minims (0.6-2.0 Cc). 

Syrupus SSnegae — Syrupi SSnegae — Syrup of Senega (20 per cent, of fluid 
extract). — Dose, 30-60 minims (2.0-4.0 Cc). 

Syrupus Scillae Compositus — Syrupi Scillae Comp6siti — Compound Syrup 
of Squill (contains 8 per cent, of Senega). (Described under Scilia, p. 635.) 

Physiological Action. — Externally and Locally .—TYi^ active 
principle of senega is a decided irritant to the skin and mucous 
membranes, causing violent sneezing and cough, with marked 
hydremia and increased secretion from the bronchial and nasal 
mucous membranes when the powder is inhaled. 

Internally .—Digestive System. — Small doses stimulate the mu- 
cous membranes of the mouth and stomach, augmenting the sali- 
vary and gastric secretions, although frequently occasioning indi- 
gestion. Large doses irritate the alimentary canal, producing 
vomiting, diarrhea, and abdominal pain. 

Circulatory System. — The active principle of senega circulates in 
the blood unchanged, affecting the heart and blood-vessels after 
the manner of digitalis, though with less power and certainty. 

Nervous System. — Under medicinal doses no important action 
has been noted. Very large doses depress the nervous system. 

Respiratory System. — It is here that senega appears to exert its 
most important influence. The excretion of the drug through the 
bronchial mucous membrane irritates the respiratory passages, oc- 
casioning hyperemia, increased secretion, and, reflexly, cough. 

Absorption and Elimination. — The active principle of senega is 



628 A TEXT-BOOK OF MATERIA MEDICA. 

absorbed with difficulty, being excreted through the bronchial 
mucous membrane and the kidneys, irritating these structures 
during the process, and consequently acting as a stimulant, expec- 
torant, and diuretic. The drug also possesses some diaphoretic 
virtue, being partially excreted by the skin. 

Temperature. — The body-heat is uninfluenced. 

Uterus. — It is believed that senega possesses emmenagogue 
properties. 

Untoward Action. — Immoderate, and in certain susceptible sub- 
jects small, doses of senega have produced irritation and burning 
in the throat, saHvation, impaired appetite, a sense of oppression in 
the stomach, nausea, vomiting, coHcky pains, and profuse diarrhea. 

Poisoning. — Senega is not regarded as a poisonous drug, exces- 
sive doses producing symptoms analogous to those of '' Untoward 
Action," save that they are intensified. 

Treatment of Poisoning. — Elimination is to be favored, and the 
symptoms treated as they appear, gastric sedatives, anodynes, and 
cardiac stimulants being employed. 

THneicSb^QVLtic^.— Externally and Locally. — No action has been 
observed. 

Internally. — The principal use of senega is that of a stimulating 
expectorant. The reputation of the drug originated with its 
efficacy in typhoid pneumonia, and it is still considered a valuable 
remedy in asthenic pulmonary diseases. 

It is highly beneficial in subacute bronchitis when the power to 
cough is feeble. In like manner senega is useful in bronchorrhea 
and chronic bronchitis with profuse expectoration, though less valu- 
able when the mucus is tough and scanty. 

The simple catarrhal laryngitis following croup is greatly 
relieved by the administration of senega. 

The drug is an appropriate remedy in ame7iorrhea the result of 
passive uterine congestion, and senegin has been recommended as 
a remedy for uterine hemorrhage. 

According to some authorities, the drug has proved beneficial 
in chronic rheumatism. 

Contraindications. — Senega is inadmissible in acute bronchitis 
and indigestion, or when there is marked irritation and inflamma- 
tion of the gastro-intestinal tract. 

Administration. — The syrup of senega is the preparation 
usually employed as an expectorant. Senegin may be given in 
doses of 2 grains (0.13 Gm.) in capsules. 



I 



EXPECTORANTS. 629 

Terebenum— Terebeni— Terebene. 77. H, P. 

Origin. — A liquid consisting chiefly of Pinene, and containing 
only very small proportions of Terpinene and Dipentene ; obtained 
by the action of Sulphuric Acid upon Turpentine, and distillation. 

Description and Properties. — A colorless or slightly yellow- 
ish, thin liquid having rather an agreeable thyme-like odor and an 
aromatic, somewhat terebinthinate taste. Only slightly soluble in 
water, but soluble in an equal volume of alcohol. Terebene should 
be kept in well-stoppered bottles, in a cool place protected from Hght. 

Dose. — 5-15 minims (0.3-1. Cc). 

Physiological Action. — When applied externally terebene acts 
as a stimulant, germicide, antiseptic, and astringent. Internally, 
small doses act as a stimulant to the gastro-intestinal tract, large 
amounts being irritant and producing effects similar to those of 
turpentine. 

The drug is ehminated by the kidneys, bronchial mucous mem- 
branes, skin, bowels, etc., acting as a mild astringent and antiseptic 
at the points of elimination. 

Therapeutics. — Externally and Locally. — The inhalation of 
terebene — 20 minims (1.23 Cc.) daily — allays the cough oilaryngeal 
phthisis and has proved beneficial in irritative bronchial cough, while 
a spray of terebene mixed with oil of eucalyptus and alcohol has 
been advised in whooping coiigli. 

Equal parts of terebene and olive oil have been recommended 
by Vaucher and Bertin in the treatment of uterine cancer. Tere- 
bene has been successfully employed as a general antiseptic dress- 
ing of wounds, tdcers, burns, etc. 

I?tternally. — Whether inhaled or taken into the stomach, terebene 
is a powerful stimulant, antiseptic expectorant in chronic bronchitis. 

The drug is of service in affections of either the upper or lower 
respiratory passages. In winter cough, bronchorrhea, emphysema^ 
and even in phthisis, it is an efficient remedy. 

Not only in bronchial affections is the drug valuable, but it has 
been used with striking success as a substitute for copaiba and oil 
of sandalwood in genito -urinary diseases. It has even been claimed 
to influence favorably the course oi puerperal fever and to relieve 
the symptoms oi flatident dyspepsia. 

Administration. — Terebene may be given in emulsion or in 
mixtures associated with other expectorants and enclosed in cap- 
sules or dropped upon sugar. 



630 A TEXT-BOOK OF MA TERIA MEDICA. 

Terpini Hydras— Terpini Hydratis— Terpin Hydrate. 

V. S. JP. 

Origin. — The hydrate of the diatomic alcohol Terpin, prepared by 
mixing rectified Oil of Turpentine, Alcohol, and Nitric Acid, allow- 
ing the mixture to stand for three or four days in shallow porcelain 
dishes, collecting the crystals which have formed, drying on ab- 
sorbent paper, and recrystallizing in a cold solution of alcohol. 

Description and Properties. — Colorless, lustrous, rhombic 
prisms, nearly odorless, and having a slightly aromatic and some- 
what bitter taste. Permanent in the air. Soluble in about 250 
parts of water and in 10 parts of alcohol. Terpin hydrate should 
be kept in well-stoppered bottles. 

Dose. — 2-30 grains (0.12-2.0 Gm.). 

Physiological Action. — Terpin hydrate is a powerful antiseptic, 
its action resembhng that of turpentine, though inferior in strength. 

Therapeutics. — Externally and Locally. — The drug is used in 
the form of lozenges and as an inhalant in chronic tracheitis and 
chronic bronchitis. 

Internally. — Terpin hydrate may be used for the same purposes 
as terebene, being considered by some physicians superior to the 
latter drug in bronchial affections. It has been recommended as 
an efficient remedy in asthma, hay fever, nephritis, and neuralgia. 

Administration. — Terpin hydrate may be given in lozenges, 
emulsion, or aromatic elixir, although the most judicious method 
of administration perhaps is in capsules. 

Terpinol is obtained by boiling terpin hydrate with dilute mineral acids. It occurs 
as an oily body with a hyacinthine odor. Insoluble in water, but readily soluble in 
alcohol and in ether. 

Terpinol is a valuable bronchial stimulant, and may be used for the same diseases 
of the respiratory passages for which terpin hydrate is recommended. 

It is best given in capsules, in doses of about 2 grains (0.12 Gm.) each, repeated 
from four to six times a day. 



GROUP XIII.— DIURETICS 

AND SUBSTANCES ACTING ON THE KIDNEYS AND THE URINARY 

SYSTEM. 

Diuretics are drugs which increase the flow of urine. Con- 
sidered in a broader sense, however, these agents augment the 
secretion and modify the character of the urine — 

I. By increasing the amount. 



DIURETICS. 631 

2. By rendering the urine acid. 

3. By rendering the urine alkahne. 

4. By removing waste products or increasing the sohd con- 
stituents of the urine. 

5. By preventing the decomposition of the urine. 

The last-named action is peculiar to benzoic * and salicyHc * 
acids, cubeb, copaiba, uva-ursi, oil of sandalwood, volatile oils,* 
saccharin, and salol.^ 

The following medicines affecting the urinary system are called 
Lithontidptics, because of their power to prevent the formation of 
concretions in the urinary passages or to dissolve them ■ when 
formed : 

Piperazin, potassium salts,* lithium salts,* ammonium benzoate,* 
benzoic acid,* dilute nitric acid.* 

Among the principal drugs which render the urine acid are — 
benzoic * and saHcylic * acids and many of their salts, immoderate 
amounts of the vegetable acids,* and sour wines.* 

The alkalies,* particularly the potassium and lithium salts, when 
taken internally, render the urine alkaline in reaction. 

Diuretics may be either Direct or Indirect — /. e. they may act 
on the kidneys themselves or upon certain structures outside the 
kidneys. The structures in the kidneys which have to do with 
the elimination of water, solids, etc. are — I. The Malpighian tufts ^ 
which eliminate principally water, but also mineral salts and certain 
pathological and foreign substances which may be present. 2. The 
glandular epithelium lining the cojivoluted tiibides, which excretes 
waste-products, such as urea, etc. 3. The constricted portion of the 
tubules, serving to prevent (according to the Cohnheim-Bauman 
theory) the too rapid escape of water, thus allowing time for its 
absorption in cases where it is desirable that the water be retained 
in the system. 

The functional activity of these various structures is regulated by 
the nervous mechanism through its influence upon the blood-supply. 
For example, the supply of blood to the glomeruli is influenced 
largely by the size of the blood-vessels, regulated by the vaso-con- 
strictor and vaso-dilator nerves ; but it has not been proven that the 
secretory cells are in any way affected by the nervous mechanism. 

Diuretics act — 

1. By increasing the general blood-pressure. 

2. By causing local dilatation of the renal arterioles. 

^ The drugs marked with an asterisk are described elsewhere in the present work. 



6^2 



A TEXT- BOOK OF MATERIA ME DIG A. 



3. By directly stimulating the glandular secreting renal structures. 

4. By simple mechanical force. 

The following table, modified from Brunton's work on Pharma- 
cology, Therapeutics, and Materia Medica, serves to elucidate the 
methods by which the various diuretic agents probably exert their 
influence : 

Increased 
action. 



Raise arterial 
pressure. 



Generally 



General vascular 
contraction. 



cardiac f Digitalis,* 
t Alcohol.* 
' Digitalis * 
Strophanthus,* 
Squill, 

Scoparius,* ~ 
Convallaria,* 
Strychnine,* 



Locally on kidneys. - 



Contract effer- 
ent vessels. 



Act on the 
motor centers 



vaso- ■) 
jrs. / 



Erythrophleum 
(cold to the skin). 

Same as above ? 



l_ Locally on kidney. 



Dilate efferent | 
vessels. \ 



Act either on vaso- 
motor centers or 
locally on renal 
vessels. 



Act on secreting 
nerves and renal 
cells. 



Increase water excreted 



Increase water and solids excreted 



By simple mechanical action 



Scoparius,* 
Buchu, 
Uva Ursi, 
Juniper, 
Turpentine, 
Copaiba, 
[ Cantharides.* 

Nitrites,* 
Alcohol* 

'' Urea, 

Caffeine,* 

Diuretin, 
. Calomel.* 
\ Colchicum.,* 
I Liquor Potassae,* 
I Potassium Acetate,* 
\ Potassium Citrate,* 
I Potassium Nitrate,* 
I Sodium Citrate * 
[ and other salines. 
f Water, local bleeding, 
-| dry cupping, warm 
I fomentations. 



The secretion of urine is considerably influenced by the activity 
of the skin and bowels ; for instance, when the cutaneous glands 
are stimulated and there is free perspiration, a diminished urinary 
secretion ensues. The functional activity of the skin and sudo- 



DIURETICS. 



633 



riparous glands depends greatly upon the amount of blood sup- 
plied to them. Whatever augments the flow of blood to these 
structures increases the secretion of the sweat-glands. Conse- 
quently, external warmth dilates the cutaneous blood-vessels and 
promotes diaphoresis, while cold contracts the cutaneous vessels, 
diverting the flow of blood to the internal organs, thereby increas- 
ing the secretion from the kidneys and lessening that from the 
skin. 

It will be seen, therefore, that the functions of the skin and 
kidneys are compensatory, the compensation being also partially 
observable in the mutual relations between the bowels and kidneys. 
It is well known that when there is active purgation, with frequent 
watery movements from the bowels, the amount of urine secreted 
is proportionally diminished. 

Any drug which increases the general blood-pressure and forces 
a larger blood-supply into the kidneys augments the pressure in 
the glomeruH, distending the capsule 
and enlarging the area of the osmotic 
membrane, which action, combined 
with an increase in the circulation, 
promotes and facilitates filtration, 
thereby augmenting the amount of 
urine. 

The membrane lining the inner 
capsule of the glomerulus is covered 
with a single layer of cubical epithe- 
lium possessing a secretory function, 
rendered more active in accordance 
with the physiological fact that the 
greater the blood-supply to a gland 
or secreting structure, the greater its 
functional activity. 

The blood-pressure in the glom- 
eruH, as has been said, may be in- 
creased by additional pressure in 
the general circulation. It may be 
raised also locally through dilatation 
of the afferent blood-vessel supply- 
ing the Malpighian corpuscle, or con- 
traction of the efferent \^^?>^\'$>, allowing a smaller quantity of blood 
to escape from the glomerules. 




Fig. 15. — A, glomerules of capillary 
blood-vessels ; B, cubical or secreting cells 
covering the membrane surrounding the 
capillary' plexus ; C, space between the 
two layers opening into a convoluted tu- 
bule ; D, the external layer covered by 
flattened epithelial cells ; E, convoluted 
tubule lined with a single layer of nucle- 
ated polyhedral epithelium ; F, afferent ar- 
tery entering the Malpighian corpuscle, 
dividing in the interior into a dense, con- 
voluted capillary plexus, which finally leads 
out of the corpuscle by G, a small, efferent 
vessel comparable to a vein, at a point op- 
posite to that where the afferent vessel 
enters the Malpighian corpuscle. 



634 A TEXT-BOOK OF MATERIA MEDICA. 

By referring to the foregoing tabular view we may ascertain 
the drugs acting upon the general and those affecting the local 
circulation. 

The preceding diagram (Fig. 15) will serve to elucidate the 
action taking place in the glomeruli: 

The secreting structures of the convoluted tubules are stimu- 
lated by the influence of certain drugs which are carried in the 
blood, acting as excitants upon the secreting cells. This neces- 
sarily requires an extra supply of blood to the part furnishing 
material for the extra secretion. By reference to the table on 
page 632 it will be seen what diuretics act upon these struct- 
ures. 

The subjoined diagram (Fig. 16) shows the structures concerned 
with the functional activity of the kidney. 




w 

Fig. 16. — I, Malpighian corpuscle ; 2, convoluted tubule with capillary plexus from efferent vessel ; 
3, constricted portion of the tubule; 4, unstriped muscle-fibers surrounding the constricted portion; 
5, afferent blood-vessel leading into the Malpighian body ; 6, efferent vessel leading out of the Mal- 
pighian corpuscle ; 7, the collecting tube. 

The imbibition of large amounts of water, while increasing the 
blood-pressure to some extent, mechanically increases the amount 
of water eliminated by the kidney. This is commonly known as 
the " flushing action," and renders the urine more dilute. 

In congested conditions of the kidneys certain remedial meas- 
ures — such as local venesection, dry cupping, warm fomentations, 
etc. — promote renal secretion. 

Therapeutics. — i. To remove excessive accmmilation of fluid in 



DIURETICS. 635 

the tissues and serous cavities of the body whe7z the blood-pressure is 
low. 

For this purpose the most efficient service is derived from the 
use of drugs which act by increasing the systemic blood-pressure, 
and stimulating the secreting cells of the kidneys. 

Ordinarily, the agents most beneficial in cardiac dropsy or drop- 
sies due to venous congestion are digitalis, calomel, scoparius, 
squill, diuretin,, etc. 

2. To rejuoi'e excess of fluid from the body when the blood-pressure 
is about normal^ as in cases of hepatic cirrhosis with dropsy. 

The remedies found to be most efficient in these conditions are 
diuretin, copaiba, and calomel, although frequently saline pur- 
gatives, by ridding the peritoneal cavity of excess of water and 
preventing the accumulation of fluid by lowering the abnormally 
high blood-pressure in the portal circulation, prove more beneficial 
than diuretics. 

3. To remove water from the blood wJien the arterial pressure is 
abnormally high. 

For this purpose diuretics are indicated in the early stages of 
many acute diseases, such as the eruptive fevers, tonsillitis, bron- 
chitis, etc. In these cases agents which dilate the cutaneous blood- 
vessels, such as spirit of nitrous ether, etc., should be employed. 
Diaphoretics and cathartics are likewise beneficial. 

4. To remove from the blood injurious waste products and poi- 
sonous substances. 

For this purpose drugs which stimulate the convoluted tubules 
and increase oxidation should be given, such as potassium nitrate 
and bitartrate, the lithium salts, turpentine, juniper, diuretin, and 
the remedies mentioned under " Lithontriptics." 

The foregoing remedies will be found useful in diseases asso- 
ciated with rheumatic, gouty, and tiric-acid diatheses, as well as in 
many acute diseases where there is rapid accumulation of deleteri- 
ous, retrograde material. 

5. To lessen the acidity of the urine. 

The alkalies and the alkaline salts of the organic acids are the 
most useful agents for this purpose, being serviceable in such con- 
ditions as gonorrhea and acute inflammatory states of the genito- 
urinary tract. In debilitated conditions there is quite often an ex- 
cessive acidity of the urine, irritating the mucous membrane and 
causing frequent micturition. In such cases the alkaline diuretics 
or alkaline mineral waters are of service. 



62,6 A TEXT-BOOK OF MATERIA MEDIC A. 

6. To increase the acidity of the urine. 

This is necessary when, from any cause, there is ammoniacal 
decomposition of the urine, as in cystitis. In such cases benzoic 
acid is probably the most beneficial remedy, though the saHcylates. 
salol, and the volatile oils, etc. may also prove useful. 

7. To prevent the formation of urinary co7tcretions or to dissolve 
them whe7i formed, as in cases of renal calculi, etc. 

For these purposes the drugs included under " Lithontriptics " 
are the most efficient. 

8. To dilute the urine. 

This process is necessary to prevent the deposit of urinary solids 
from farming calcidi in the kidneys or bladder. For this purpose 
water or the alkaline mineral waters, taken in large quantities, will 
prove most useful. 

Admmistration. — Diuretics are often very uncertain in their 
action, in health many of them apparently exerting no influence 
upon the kidneys, and in diseased conditions not infrequently 
proving inert. They are more certain in their action when em- 
ployed in combination — that is, a union of drugs which act both 
generally upon the systemic circulation and locally upon the 
various secreting structures of the kidneys. Diaphoretics, being 
diverse in their action, should not be given with diuretics. 

When administered, diuretics should be freely diluted with 
water. The patient's skin should be kept cool and the bowels 
prevented from acting too freely, in order that the full benefit of 
this class of remedies may be obtained. 

The diuretic drugs not described elsewhere in the present work 
are herewith considered in detail. 

ScTIla—ScTlIae— Squill. V.H. J>. 

Origin. — The bulb of Urginea maritima (L.) Baker, a plant in- 
digenous in the basin of the Mediterranean from Syria westward to 
the coast of the Atlantic. The bulb is deprived of its dry, mem- 
branaceous outer scales and cut into thin slices, the central por- 
tions being rejected. 

Description and Properties. — Occurring in narrow segments 
about 2 inches (5 Cm.) long, slightly translucent, yellowish-white 
or reddish, brittle and pulverizable when dry, tough and flexible 
after exposure to damp air ; inodorous ; taste mucilaginous, bitter, 
and acrid. The drug contains three active principles — scillipicrin, 



DIURETICS. 637 

scillitoxin (both acting upon the heart), and scilli7i (an emetic prin- 
ciple) — together with various unimportant substances, such as mu- 
cilage, sugar, etc. 

Dose. — 1-4 grains (0.06-0.25 Gm.). 

Official Prepai^ations. 

Acetum Sc!llae-Aceti Scillse — Vinegar of Squill (10 per cent.). — Dose, 10-30 
minims (0.6-2.0 Cc). 

ExtrSctum Scillae Fluidum — Extr^cti Scillae Fluidi — Fluid Extract of 
Squill. — Dose, 1-4 minims (0.065-0.25 Cc). 

Syrupus Scillae— Syrupi Scillae— Syrup of Squill (45 per cent, of the Acetum). 
— Dose, 30—60 minims (2.0-4.0 Cc). 

Syrupus Scillae Compdsitus — Syrupi Scillae Compdsiti — Compound Syrup 
of Squill. — Dose, 15 minims-2 fluidrachms (1.0-8.0 Cc). Fluid Extract 8 per cent., 
with Fluid Extract of Senega 8 per cent, and Tartar Emetic 2 per cent., or \ grain (.008 
Gm.) to I fluidrachm (4.0 Cc). 

Tinctura Scillae— Tincturae Scillae— Tincture of Squill (15 per cent.). — Dose, 
5-20 minims (0.3-1.3 Cc). 

Antag-onists and Incompatibles. — The action of squill upon 
the circulatory system is antagonized by the cardiac depressants. 
Tannic acid is incompatible. 

Synergists. — The diuretic action of squill is enhanced by the 
diuretics and many of the cardiac stimulants. As an expectorant 
the drug is aided by senega and tartar emetic. 

Physiolog-ical Action. — Externally and Locally. — There is no 
action of special importance. Applied to mucous membranes, 
however, squill acts as an irritant. 

Internally. — Digestive System.— Y^'d.xg^ doses of the drug excite 
nausea, vomiting, and purging. Excessive amounts may produce 
gastro-enteritis. 

Circulatory Syste7n.— The action of squill upon the heart and 
blood-vessels resembles that of digitahs, although as a cardiac 
stimulant digitalis is the more powerful. 

Nervous System. — Poisonous doses produce marked cerebral 
symptoms, and in warm-blooded animals may occasion paralysis 
and convulsions. 

Respiratory System. — The bronchial mucus is increased and 
expectoration facilitated by small doses of squill. Toxic doses 
render the respiration rapid and shallow. 

Absorption and Elimination. — The active principles of squill are 
quickly diffused through the blood, being eliminated chiefly by the 
kidneys and bronchial mucous membrane. 

In the passage of squill through the kidneys the latter are 



638 A TEXT-BOOK OF MATERIA MEDIC A. 

stimulated by the drug, which influence, together with the drug's 
action upon the systemic circulation, renders squill an active and 
valuable diuretic, increasing not only the amount of urine, but also 
the quantity of inorganic solids. 

Very large doses irritate and inflame the kidneys, resulting in 
strangury and hematuria, with occasionally entire suppression of 
urinary flow. 

Untoward Action. — This does not differ essentially from the 
symptoms of " Poisoning." 

Poisoning. — In toxic doses squill acts as an acro-narcotic poison. 
The symptoms produced by excessive doses are — nausea, violent 
vomiting, serous and bloody diarrhea, severe griping, a sensation 
of burning in the throat, vesical tenesmus accompanied by pain, 
bloody urine, and perhaps entire suppression of the urinary flow. 
The pulse is feeble and slow or sometimes rapid, the symptoms 
terminating in collapse and death, occasionally preceded by convul- 
sions. 

Treatment of Poiso7iing. — The stomach should be evacuated and 
demulcent drinks freely given. Opium may be necessary to relieve 
pain, while diffusible stimulants serve to counteract cardiac and 
respiratory depression. 

Therapeutics. — Squill is not used externally and locally. It 
has been employed internally as a diuretic in dropsy. When asso- 
ciated with digitalis and calomel it is an exceedingly active diuretic 
in cases of cardiac dropsy, chronic pleurisy, and pericarditis with 
effusion. 

Squill is an efficient expectorant, the vinegar, syrup, and com- 
pound SYRUP OF SQUILL being useful preparations in subacute and 
chronic forms of bronchitis, particularly when the sputum is tena- 
cious and with difficulty expelled. 

Contraindications. — Squill should not be employed in cases of 
acute diseases of the kidneys. It is also inadmissible in acute 
bronchitis and in phthisis. 

Administration. — Any of the preparations of the drug may be 
given, to be prescribed well diluted with syrup or glycerin. 

Inasmuch as the diuretic action of squill ceases after a while, 
the doses should be repeated and gradually enlarged until some 
untoward action supervenes, when further increase should be sus- 
pended. 

Because of its too irritating properties the drug is seldom given 
alone when desired for its diuretic action. 



DIURETICS. 639 

Owing to the free acetic acid which it contains, syrup of squill 
is incompatible with ammonium carbonate and other alkalies. 

Erythrophleum— Erythrophlei— Erythrophleum. 

(Casca Eark.) 

Orig-in. — A glucosid obtained from the bark of Erythrophloeum 
Gidnense Don, known under the names of Casca bark, Sassy bark, 
and Ordeal bark. The tree is a native of West Africa, the plant 
being used by the natives as an ordeal in witchcraft. 

Description and Properties. — Erythrophlein hydrochloride, 
the salt usually employed, occurs in the form of whitish crystals, 
soluble in water. 

Dose. — g^Q - j^^2 g^ain (.001-005 Gm.). 

Physiological Action and Therapeutics. — The powdered bark 
when inhaled causes violent sneezing. The tincture of the bark, 
or the glucosid, when taken in poisonous doses occasions nausea, 
vomiting, purging, intense headache, intoxication, convulsions, and 
death. 

In medicinal doses the drug affects the circulatory system after 
the manner of digitalis, and acts upon the kidneys as an active 
diuretic. It was at one time supposed to be a powerful local anes- 
thetic ; further examination, however, has proved the claim to be 
unfounded. 

Casca bark or its glucosid has been employed in intermittent 
fever, diarrhea, dyse?ttery, and dyspepsia. Its chief medical uses 
are in valvular diseases of the heart and as a diuretic in cardiac 
and renal dropsies. 

Administration. — A tincture of the bark (10 per cent, strength) 
may be given internally, diluted with water, in doses of 5-10 min- 
ims (0.3-0.6 Cc). Erythrophlein hydrochlorate is usually given 
hypodermically. 

Buchu— Buchu— Buchu. TJ, S. P. 

Origin. — The leaves of Barosma bettdina (Thunberg) Bartling 
et Wendland, and Barosma cremdata (L.) Hooker, plants or shrubs 
attaining a height of several feet, indigenous in the southern por- 
tion of Africa, particularly in various parts of Cape Colony. 

Description and Properties. — The leaves are -J to f inch (12 
to 19 Mm.) long, roundish-obovate, with a rather wedge-shaped 
base, or varying between oval and obovate, crenate or serrate, with 
a gland at the base of each tooth, dull yellowish-green, thickish, 



640 A TEXT-BOOK OF MATERIA MEDIC A. 

pellucid-punctate ; odor and taste strongly aromatic, somewhat 
mint-like, pungent, and bitterish, Buchu contains from i to 1.56 
per cent, of a volatile oil, which, on exposure to a low temperature, 
releases barosma camphor or diosphenol, a stearopten. The bitter 
principle of buchu is rittin ; resin is also present. 
Dose. — 15-30 grains (1.-2. Gm.). 

Official Preparation. 

Extractum Buchu Fluidum— Extr^cti Buchu Fluidi— Fluid Extract of 
Buchu. — Dose, 15-30 minims (i.-2.Cc.). 

Physiological Action and Therapeutics. — Externally and 
locally buchu has no action of importance. When ingested it 
acts as a carminative, in small doses occasioning a feeling of 
warmth, but in excessive doses acting as an irritant. 

Upon the circulation the influence of the drug is that of a mild 
stimulant. 

Its active constituents are rapidly diffused through the blood, 
and are eHminated principally by the kidneys, the bronchial mucous 
membrane sharing in the excretory process. 

Buchu increases the fluid and solid constituents of the urine, 
imparting to it a peculiar aromatic odor. The drug acts as a tonic 
astringent and disinfectant to the mucous membranes, from which 
it is eliminated, diminishing the secretions. 

If taken for too long a period, irritation and inflammation of the 
kidneys are apt to ensue because of excessive stimulation. 

The drug is chiefly employed as a stimulant diuretic and expecto- 
rant in catarrhal conditions of the genito-urinary organs and bron- 
chial tubes. Buchu is therefore of service in urethritis, gonorrhea, 
gleet, chronic cystitis, incontinence of urine due to want of muscular 
tone, pyelitis, etc. The drug has also proved beneficial in certain 
cases of chro7iic bro7ichitis, and has even been recommended in 
chronic rheumatism and lithemia. 

Contraindications. — Buchu is contraindicated in acute inflam- 
mation of the kidneys. 

Administration. — The fluid extract and the infusion are the 
only preparations employed. They should be given freely diluted 
with water. 

Uva Orsi— Uvae Ursi— Uva Ursi. V. S. P. 

(Bearberry.) 
Origin. — The leaves of Arctostaphylos Uva Ursi (L.) Sprengel., 
a trailing evergreen plant distributed throughout the northern por- 



DIURETICS. 641 

tion of North America, extending as far south as New Jersey and 
westward to Colorado. The plant is also found in most parts of 
Europe and in Northern Asia. 

Description and Properties. — Leaves very short-stalked, 
obovate or oblong-spatulate, coriaceous, about |- inch (2 Cm.) long 
and ^ to -J- inch (6 to 8 Mm.) wide, obtuse, with slightly revolute 
edges, upper surface with depressed veins, lower surface distinctly 
reticulate ; odor faint, hay-hke ; taste strongly astringent and some- 
what bitter. 

Uva ursi contains two bitter glucosids, arbutiii and ericolin^ and 
a tasteless principle, urzone, besides tannic and gallic acids. 

Dose. — 15-60 grains (1.-4. Gm.). 

Official Preparations. 

Extractum Uvae Ursi — Extract! Uvse Ursi — Extract of Uva Ursi. — Dose, 
5-15 grains (0.3-1.0 Gm.). 

ExtrSctum tJvae Ursi Fluidum— Extr^cti Uvae Ursi Fluidi— Fluid Extract 
of Uva Ursi. — Dose., 15-60 miniins (1-4 Cc). 

The Physiolog'ical Action and Therapeutics of uva ursi are 
analogous to those of buchu. 

JunTperus—JunTperi— Juniper. 

(Juniper Berries.) 

Origin. — The fruit of Juniperus communis (L.), an evergreen 
tree indigenous in the northern hemisphere and found in the 
United States and Canada and in Europe. 

Description and Properties. — Berries globular, about the size 
of a large pea, externally of a glossy, purplish-black color, covered 
with a grayish bloom. They have an aromatic, balsamic odor, and 
a sweet terebinthinate, bitterish, and slightly acrid taste. Juniper 
contains a volatile oil ; also juniperin, sugar, wax, fat, etc. 

Dose. — 15-60 grains (1.-4. Gm.). 

Oleum JunTperi— Qlei JunTperi— Oil of Juniper. 

JJ. S. J>. 

Origin. — A volatile oil distilled from the fruit of Juniperus 
communis. 

Description and Properties. — A colorless or faintly greenish- 
yellow liquid, becoming darker and thicker through age and 
exposure to air, having the characteristic odor of juniper and 

41 



642 A TEXT-BOOK OF MATERIA MEDICA, 

a warm, aromatic, somewhat terebinthinate and bitterish taste. Sol- 
uble in about four times its volume of alcohol, forming a more or 
less turbid liquid, which is neutral or slightly acid to litmus-paper. 
Dose. — 5-15 minims (0.3-1.0 Cc). 

Official Preparations. 

Spiritus Juniperi— Spiritus Juniperi— Spirit of Juniper.— Z><?j^, 1-8 fluidrachms 
'(4.0-30.0 Cc). Formula: Oil of Juniper, 5; Alcohol, 95 parts. 

Spiritus Juniperi CompSsitus— Spiritus Juniperi Comp6siti— Compound 
Spirit of Juniper.— Formula : Oil of Juniper, 8 ; Oil of Caraway, i ; Oil of Fennel, 
i; Alcohol, 1400; Water sufficient to make 2000 parts.— Z>o.y^, 2-4 fluidrachms 
(8.0-15.0 Cc). 

Unofficial Preparations. 

Extractum Juniperi Frtictus Fluidum— Extracti Juniperi Frtictus Fluidi— 
Fluid Extract of Juniper Berries. — Dose, 15-60 minims (1.0-4.0 Co.). 

Infusum Juniperi — Infusi Juniperi — Infusion of Juniper. — i ounce (31. Gm.) 
of Juniper to i pint (473. Cc.) of Water. — Dose, 2-4 fluidounces (6o.-n8. Cc). 

Physiolog'ical Action and Therapeutics. — Juniper in its action 
resembles buchu, being a stimulant diuretic. Under certain condi- 
tions it acts as a diaphoretic. It is a tonic to the stomach and 
a mild aphrodisiac. 

The volatile oil, which is the active constituent of juniper, 
diffuses through the blood with great facility, stimulating the heart, 
and, in dropsical conditions, increasing the flow of urine. In 
health, however, the amount of urine is diminished, while that 
of urea is augmented. 

Juniper is used for the same purposes as buchu — being superior 
to the latter drug perhaps — especially in various dropsies and 
passive congestion of the kidneys. 

Contraindications. — The same as for buchu. 

Administration. — Any of the preparations may be given, gin 
being a popular diuretic. 

Oleum Terebinthinae— Olei Terebinthinae— Oil of 
Turpentine. 77. 8. J*. 

Origin. — A volatile oil distilled from turpentine — a concrete 
oleoresin obtained from Pinus palustris Miller and other species 
of Pinus. 

Description and Properties. — A thin, colorless liquid, of a 
characteristic odor and taste, both of which become stronger and 
less agreeable with age and exposure to air. Soluble in three 



DIURETICS. 643 

times its volume of alcohol. Oil of turpentine should be kept 
in well-stoppered bottles, protected from light. 
Dose. — 5-15 minims (0.3-1.0 Cc), in emulsion. 

Official Preparations. 

LinirnSntum Terebinthinae — LinimSnti Terebinthinae — Turpentine Lini- 
ment (35 per cent, with resin cerate). For external use. 

Oleum Terebinthinae Rectificatum — Olei Terebinthinae Rectificati— Rec- 
tified Oil of Turpentine. — Dose, 5-15 minims (0.3-1.0 Cc.). 

Antag-onists and Incompatibles. — The motor depressants and 
agents increasing waste therapeutically antagonize the action of 
turpentine. Bromine, iodine, and nitric and sulphuric acids are 
incompatible, explosion occurring with the first two, and combus- 
tion taking place by mixture with the acids named. 

Synergists. — The therapeutic actions of turpentine are enhanced 
by buchu, cubeb, copaiba, oil of sandalwood, and the diffusible and 
alcoholic stimulants. 

Physiological Action. — Externally and Locally. — Oil of turpen- 
tine is antiseptic, hemostatic, irritant, counter-irritant, rubefacient, 
vesicant, and a parasiticide. Its action resembles closely that of 
the volatile oils as described under " Aromatics." 

When appHed to the epidermis the drug dilates the cutaneous 
blood-vessels, occasioning a sensation of heat and producing red- 
ness of the skin, and, if the oil be applied with inunction for any 
length of time, vesication ensues, with, occasionally, intractable 
ulcerations. The fumes of oil of turpentine when inhaled cause 
great irritation of the eyes and the respiratory passages. 
The drug is readily absorbed from the unbroken skin. 
Internally. — Digestive System. — When taken into the mouth 
turpentine produces a burning, pungent taste and an immediate and 
augmented salivary secretion. Swallowed in immoderate amounts, 
the drug occasions a sensation of heat in the epigastrium, with in- 
creased peristaltic action and secretion. The intestines are simi- 
larly affected, the intestinal peristalsis being greatly augmented, the 
drug acting as an efficient carminative. 

Large doses of turpentine produce severe, burning pain in the 
stomach and bowels, accompanied by nausea, vomiting, and purg- 
ing, the feces often containing blood. 

The drug is an efficient anthelmintic for tape-worm. 
Circ7ilatory System. — Turpentine is a cardiac stimulant, increasing 
the force and rapidity of the heart's action and raising arterial ten- 



644 ^ TEXT-BOOK OF MATERIA MEDICA. 

sion by direct cardiac influence. The blood-vessels are contracted 
by the drug, which may account for its hemostatic properties. 
Very large doses slow the heart by stimulating the vagus inhibitory 
center. 

Nervous System. — Small doses increase and large doses dimin- 
ish reflex excitability. Large doses produce giddiness, mental 
exhilaration, and incoherence of ideas, followed by dulness and 
occasionally coma. 

There is incoordination of movements, resulting in unsteady 
gait, great muscular weakness, and diminished sensation, usually 
preceding the impairment of voluntary motion. 

Respiratory System. — The effect of inhaled oil of turpentine on 
the respiratory passages has been described. When ingested the 
drug increases and disinfects the bronchial secretion. Small doses 
increase and large doses diminish the respiratory movements. 

Absorptiofi and Elimination. — Oil of turpentine is rapidly diffused 
in the blood, in moderate doses stimulating the kidneys and in- 
creasing the flow of urine, to which it imparts the odor of violets. 
Large doses irritate the kidneys, lessening the amount of urine, 
rendering it highly colored, and in some cases producing albu- 
minuria, hematuria, and even total suppression. There are present 
priapism and a frequent desire to micturate. 

Turpentine is rapidly eliminated from the system, not only by 
the kidneys, but by the skin, and bronchial and intestinal mucous 
membranes as well. 

Temperature. — The drug is a mild antipyretic. 

Untoward Action. — Erythema and eczematous eruptions are 
produced by both the ingestion and the local appHcation of turpen- 
tine. In susceptible individuals small doses may occasion serious 
disturbances of the genito-urinary and gastro-intestinal tracts, such 
as strangury, painful erections, salivation, and stomatitis. 

The administration of repeated doses of oil of turpentine may 
produce peculiar nervous manifestations, such as headache, drowsi- 
ness, dizziness, and a sense of mental vacuity. 

Poisoning. — Few cases are recorded of death resulting from the 
ingestion of excessive amounts of turpentine, owing to the fact 
that the greater amount of the drug passes away through the 
bowels. 

The symptoms produced by very large doses are — great mus- 
cular weakness, abolition of reflexes, and violent vomiting and 
purging, with bloody evacuations from the bowels. There is great 



DIURETICS. 645 

irritation of the genito-urinary tract, with constant efforts to mic- 
turate, hematuria or entire suppression of urine, painful priapism, 
and violent strangury. 

The skin is moist, and the face flushed or cyanosed, while dila- 
tation of the pupils, slow, labored, and stertorous breathing, and 
occasionally paroxysms of convulsive coughing, may be attendant 
symptoms. 

Either great mental excitement or profound insensibility^ may be 
present. The heart and circulatory system are greatly depressed, 
death, when occurring, being usually the result of cardiac failure. 

Treatment of Pois oiling. — The stomach should be at once evacu- 
ated, and elimination favored by every possible means. The free 
administration of demulcent drinks is advisable, while to relieve 
pain opium may be given. Other symptoms should be treated 
according to their indications. 

Therapeutics. — Externally and Locally. — Oil of turpentine is 
an efficient counter-irritant, being employed as such in lumbago, my- 
algia, iieuralgia, rheumatic pains, bronchitis, pleurisy, and various 
forms of chro7iic inflammation. A turpentine stupe is perhaps the 
most effective method in the local application of the drug. It is 
applied as follows: (i) A flannel is wrung out of hot water, 
sprinkled well with the oil and allowed to remain in contact with 
the affected part from five to twenty minutes, as indicated by the 
sensibility of the skin. Care must be taken in the preparation of 
the flannel lest the patient be chilled or scalded. (2) A vessel 
containing the oil is placed in hot water and a flannel wrung from 
the oil applied as desired. 

A TURPENTINE STUPE is perhaps the most grateful and efficient 
local application in peritonitis. 

Owing to its antiseptic and hemostatic properties the oil of 
TURPENTINE is frequently and beneficially employed as a dressing 
for lacerated zvounds. 

The drug is an active parasiticide, and has been used success- 
fully in the treatment of tinea tonsurans, etc. It has also been 
favorably recommended, when diluted with some bland oil, as a 
remedy for alopecia areata and psoriasis. 

Turpentine serves a useful purpose in many diseases of the ear 
and tJiroat. 

Cecchini uses turpentine in the treatment of caries of the tem- 
poral bojie. 

J. Solis Cohen recommends the vapor of turpentine as an 



646 A TEXT-BOOK OF MATERIA MEDICA. 

efficient means of allaying the cough and indtation occasioned by 
acute laryngeal catarrh. 

Erichsen employs the drug as a hemostatic to check bleeding 
after excision of the tonsils. 

The inhalation of the oil of turpentine lessens pulmonary 
hyperemia and excessive bronchial secretion. 

The drug has been recommended as a local application in 
diphtheria after the removal of the membranes. 

Internally. — Turpentine is a valuable remedy for gastric or 
httestinal flatulence, particularly when the condition arises from 
an atonic state of the muscles of the stomach or intestines. 

The drug is frequently employed in typhoid fever, not only for 
the relief of tympanitis, but also to check intestinal hemorrhage. 

In chronic intesthial catarrh, as well as in a catarrhal condi- 
tion of any mucous membrane, turpentine is a valuable remedial 
agent. 

The drug is an effectual hemostatic when given internally, 
having been successfully employed in hemoptysis, hematemesis, 
hematuria, menorrhagia, purpura hcemorrhagica, etc. 

Turpentine is a very powerful anthelmintic against tape-worm. 
When given for this purpose it should be administered in a single 
large dose, from 4-8 fluidrachms (i 5.-30. Cc), together with a 
large dose of some purgative Hke castor-oil to ensure the prompt 
elimination of the turpentine from the bowels. 

As a cardiac stimulant turpentine is often employed in low and 
depressed conditions of the circulatory system, such as typhoid, 
yellow, and puerperal fevers, pneumonia, capillary bronchitis, trau- 
matic erysipelas, etc. 

As has been suggested, the drug has a decided and beneficial 
influence upon relaxed and chronic catarrhal conditions of m.ucous 
membranes, rendering this remedy of great value in bronchorrhea, 
chronic bronchitis, emphysema with marked bronchial catarrh, etc. 
This action upon the mucous membranes, together with the diu- 
retic properties of the drug, renders turpentine an exceedingly 
valuable remedy in the treatment of gleet, subacute gonorrhea, 
chronic cystitis, spermatorrhea, prostatorrhea, pyonephrosis, etc. 

Old ozonized oil of turpentine is one of the best antidotes 
and prophylactics in cases of phosphorus-poisoning. 

So-called atonic incontinence of urine is frequently benefited by 
the drug ; and Durand has highly recommended oil of turpen- 
tine as a solvent of biliary calculi. 



DIURETICS. 647 

Contraindications. — Oil of turpentine should never be given 
to patients suffering from Bright's disease or acute inflammation 
of the gastro-intestinal and genito-urinary tracts. 

The drug should be withheld in cases of active hemorrhage in 
plethoric subjects ; and, while some authorities recommend turpen- 
tine in hematuria, others class this condition as a contraindication. 
If given in the latter condition, the dose should be small and 
cautiously repeated. 

Administration. — Small doses of turpentine may be given on 
lumps of cut sugar, but usually preference is given to administra- 
tion in the form of a capsule or an emulsion, i fluidrachm (4. Cc.) 
of mucilage of acacia, if properly manipulated, emulsifying \ fluid- 
drachm (2. Cc.) of oil of turpentine with i fluidounce (30. Cc.) of 
water. Flavoring substances can be incorporated in the emulsion, 
rendering the preparation not unpleasant to the taste. 

In giving turpentine its tendency to produce untoward manifes- 
tations, particularly of the genito-urinary tract, should be remem- 
bered, care being invariably exercised in the administration of the 
drug. 

For external use the drug may be used in full strength, diluted 
with some bland oil or ointment, or applied in the form of stupes. 

Turpentine is sometimes employed as an enema, in which case 
it should, of course, be mixed with some bland oil and mucilage 
of acacia in the form of an emulsion. 



Copaiba— Copaibae— Copaiba. 77. 8. JP. 

(Balsam of Copaiba.) 

Origin. — -The oleoresin of Copaiba Langsdorffii (Desfontaines) 
O. Kuntze, and other species of Copaiba^ lofty forest trees, natives 
of Central America. 

Description and Properties. — A transparent or translucent, 
more or less viscid liquid of a pale-yellow to brownish-yellow 
color, having a peculiar aromatic odor and a bitter acrid taste. 
Insoluble in water ; readily soluble in absolute alcohol, ether, chlo- 
roform, carbon disulphide, benzin, and fixed and volatile oils. 

Copaiba contains a volatile oil, two resins, copaibic acid (soluble 
in absolute alcohol and in ammonia), and a bitter principle. The 
term " balsam " is a misnomer, since the drug contains neither 
benzoic nor cinnamic acid. 

Dose. — 5-30 minims (0.3-2.0 Cc), in emulsion or in capsule. 



648 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparation. 

MSssa Copalbae — MSssse Copaibae — Mass of Copaiba. — Formula: Copaiba, 
94; Magnesia, 6; Water, a sufficient quantity. — Dose, 5-30 grains (0.3-2.0 Gm.). 

Oleum Copalbae— Olei Copalbae— Oil of Copaiba. 

V. S. I". 

Orig-in. — A volatile oil distilled from Copaiba. 

Description and Properties. — A colorless or pale-yellowish 
liquid, having the characteristic odor of copaiba and an aromatic, 
bitterish, and pungent taste. Soluble in about ten times its volume 
of alcohol, forming a slightly turbid Hquid, which is neutral to 
litmus-paper. The drug should be kept in well-stoppered bottles, 
in a cool place. 

Dose. — 5-15 minims (0.3-1 Cc). 

Resina Copaibae— ResTnae Copalbae— Resin of 
Copaiba. U. S. J>. 

Origin. — The residue left after distilling off the volatile oil from 
Copaiba. 

Description and Properties. — A yellowish or brownish-yellow, 
brittle resin, having a slight odor and taste of copaiba. Soluble in 
alcohol, ether, chloroform, carbon disulphide, benzol, and amylic 
alcohol. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Antagonists and Incompatibles. — Copaiba is antagonized by 
the same drugs which antagonize turpentine. It is pharmaceuti- 
cally incompatible with aqueous preparations. 

Synergists. — The same as for turpentine. 

Physiological Action. — Externally and Locally. — Copaiba has 
no influence of importance, being but slightly stimulant to the 
skin. 

Internally. — Digestive System. — Its action is analogous to that 
of turpentine and the volatile oils. The ingestion of the drug, 
even in small doses, is almost always succeeded by eructations 
tasting of copaiba. 

Copaiba exerts no special influence upon the circulatory, ner- 
vous, and respiratory systems. 

Absorption and Elimination. — The drug enters the circulation 
with facility, and is slowly eliminated by the skin and mucous 
membranes generally, although chiefly by the kidneys. The resin 
which the drug contains is a powerful stimulant of the genito- 



DIURETICS. 649 

urinary structures, increasing the quantity, and to some extent the 
soHd constituents, of the urine. Large doses irritate the kidneys, 
occasionally producing strangury, bloody urine, pain in the blad- 
der, etc. 

Under the use of copaiba albumin is sometimes found in the 
urine. Frequently the nitric-acid test with urine may give a reac- 
tion as if for albumin, the conclusions being then erroneous, since 
the resin of copaiba eliminated in the urine is by the action of 
nitric acid precipitated as a milky cloud, readily differentiated from 
albumin by heating the urine or mixing it with alcohol, by both of 
which means the resinous precipitate is dissolved. 

Copaiba acts as a stimulant and disinfectant at the points of 
•elimination, in medicinal amounts increasing secretion and impart- 
ing to the secretion from the kidneys, bronchial mucous membrane, 
and skin a peculiar, fragrant odor. 

Untoward Action. — It often happens that after a few days' ad- 
ministration of copaiba there is produced in certain individuals an 
eruption, usually resembling roseola, which later may be trans- 
formed into true papules. Or the eruption may be scarlatiniform 
in character or a true eczema ensue. These eruptions are first 
noticeable on the upper and lower extremities, backs of the hands 
and knees, malleoli, etc., and are attended with intense itching. 

Under the prolonged use of the drug there may occur serious 
disturbances of the digestive and genito-urinary tracts. 

Poisoning. — In addition to the untoward manifestations already 
mentioned, very large doses of copaiba produce symptoms similar 
to those described under Turpentine. Cases have been recorded 
in which excessive amounts occasioned paralysis and tetanoid 
attacks. 

Treatment of Poisoning. — This should be the same as prescribed 
under Turpentine. 

Therapeutics. — Externally and Locally. — The use of copaiba 
has recently been revived by Dr. Beach of Boston as a protectant 
antiseptic and antiphlogistic dressing for the treatment of chronic 
and indolent ulcers. 

It has been advocated as an excellent application in many 
chronic diseases of the skin, such as psoriasis, hipns, etc. The 
drug has proved valuable in frost-bites, while Shoemaker mentions 
it as a useful remedy to apply to " thickened and irritable conditions 
of the tongue, mouth, rectum, vagina, uterus, and urethra!' The 
same authority affirms that the drug sometimes completely re- 



650 A TEXT-BOOK OF MA TERIA MEDICA. 

moves the discharge of gleet when appKed directly to the ure- 
thra. 

Internally. — The principal use of copaiba is as a stimulant and 
disinfectant of the genito-urinary tract in cases of gleet, subacute 
gonorrhea, vaginitis, cystitis, pyelitis, etc. 

In ascites and dropsical conditions, particularly those due to 
hepatic and cardiac disease, the resin of copaiba proves a very 
efficient and reliable diuretic. Under prolonged use, however, a 
tolerance appears to be established. 

Copaiba is a valuable remedy in cJironic bronchitis and bronchor- 
rhea with offensive expectoration. 

The drug has been at times given internally with good results 
in psoriasis, urticaria, etc., although the internal use of copaiba in 
these disorders is less common than formerly. 

The drug has found enthusiastic advocates as a remedy in 
chronic diarrhea and dysentery, and has also been recommended 
in chronic proctitis and clironic intestinal catarrh. 

Contraindications. — The same as for turpentine. 

Administration. — The methods of administration recommended 
for turpentine are applicable to this drug. It is claimed that many 
of the untoward manifestations produced by copaiba may be pre- 
vented by giving the drug with an alkah. With this object in 
view copaiba was associated with magnesia in the " Massa Copaibae."^ 
Yet, while this preparation is perhaps less likely to produce unto- 
ward results, it is undoubtedly less active therapeutically than the 
single drug. 

Oleum Santali— Olei Santali— Oil of Santal. 
JJ. S. JP. 

(Oil of Sandalwood.) 

Origin. — A volatile oil distilled from the wood of Sa^italuin 
album L., a small tree indigenous in Southern India and portions 
of the East Indies. 

Description and Properties. — A pale-yellowish or yellow, 
somewhat thickish liquid, having a peculiar, strongly aromatic 
odor and a pungent, spicy taste; readily soluble in alcohol. It is 
frequently adulterated with oil of cedar. 

Dose. — 5-20 minims (0.3-1.2 Cc). 

Physiological Action and Therapeutics. — The action of oil of 
sandalwood resembles closely that of copaiba, and it may be given 
for the same purposes as the latter drug, although oil of sandal- 



DIURETICS, 651 

wood is more popular, and ordinarily a more efficient remedy, for 
gonorrhea, particularly in the early stages. 

Administration. — The same as in the case of copaiba. 

Cubeba— Cubebae— Cubeb. V. S. J>. 

Origin. — The unripe fruit of Piper Ciibeba Linn, fil, a climbing 
diecious shrub about 20 feet (6 M.) high, indigenous in Java. 

Description and Properties. — Globular, about -g- or |- inch 
(4 or 5 Mm.) in diameter, contracted at the base into a rounded 
stipe about J or f inch (6 or 10 Mm.) long, reticulately wrinkled, 
blackish-gray, internally whitish and hollow ; odor strong, spicy ; 
taste aromatic and pungent. It contains from 5 to 15 per cent, 
of a volatile oil, an odorous principle, cubebin, and a diuretic prin- 
ciple, ciibebic acid, besides resin, fat, wax, and starch. 

Dose. — 5-60 grains (0.32-4.0 Gm.). 

Official Preparations. 

Extractum Cubebae Fluidum— Extr^cti Cubebae Fluidi — Fluid Extract of 
Cubeb. — Dose, 5-60 minims (0.32-4.0 Cc). 

Oleoreslna Cubebae — Oleoresinae Cubebae — Oleoresin of Cn'b&'b.— Dose, 15-, 
30 minims (0.32-2.0 Cc). 

Tinctura Cubebae — Tincturae Cubebae — Tincture of Cubeb (20 per cent). 
— Dose, ]4.-2 fluidrachms (2.0-8.0 Co.). 

Trochisci Cubebae — Trochiscos (ace.) Cubebae — Troches of Cubeb. (Each 
troche contains % minim (.043 Cc.) of the oleoresin.) — Dose, I to 6 troches. 

Oleum Cubebae— Olei Cubebae— Oil of Cubeb. 

U. S. 1*. 

Origin. — A volatile oil distilled from Cubeb. 

Description and Properties. — A colorless, pale-greenish, or 
yellov/ish liquid, having the characteristic odor of cubeb and 
a warm, camphoraceous, aromatic taste. Soluble in an equal 
volume of alcohol. It should be kept in well-stoppered bottles, 
in a cool place, protected from Hght. 

Dose. — 5-15 minims (0.3-1.0 Cc). 

Antagonists and Incompatibles, — The motor depressants an- 
tagonize the action of cubeb. 

Synergists. — Buchu, copaiba, oil of santal, black pepper, and 
many of the aromatics and volatile oils. 

Physiological Action. — Externally and Locally. — Like the 
aromatics and drugs containing a volatile oil, cubeb is irritant and 
rubefacient when applied by inunction. 



6^2 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — Digestive System. — In medicinal amounts cubeb is 
an aromatic stomachic, increasing the appetite and improving 
digestion. As is the case with other drugs of this class, large dos- 
age or the too prolonged use of small amounts irritates the stomach 
and deranges digestion, cubeb acting as a laxative and occasioning 
a sensation of heat and discomfort about the rectum. 

Circulatory System. — Like other members of the Pepper family, 
cubeb enters the blood with facility, and increases the force and 
frequency of the heart's action. 

Nervous System, — No important action has been noted. 

Respiratory System. — There is no perceptible effect when the 
drug is given in medicinal doses. 

Absorption and Elimination. — Cubeb is absorbed and eliminated 
with considerable rapidity. It escapes from the system chiefly by 
the urine, though the skin and bronchial mucous membrane share 
in the excretory process. The drug acts as an active stimulant 
and disinfectant to the structures by which it is excreted, and is 
consequently a diuretic expectorant and mild diaphoretic. 

The urine and the amount of uric acid are increased by cubeb, 
the drug appearing in the urine as a salt of cubebic acid, which 
may be precipitated by nitric acid, the precipitate resembling that 
of albumin. 

Untoward Action. — Cubeb occasionally produces great disturb- 
ance in the gastro-intestinal tract, coHcky pains, and diarrhea. 
The most frequent untoward manifestations, however, are various 
cutaneous eruptions, appearing in the form of papules, and often- 
times as a diffuse erythema. No febrile symptoms attend these 
eruptions, which usually disappear shortly after the suspension of 
the drug. 

Poisoning. — Although cubeb is not regarded as a poison, v^xy 
large doses may be followed by all the symptoms of severe gastro- 
intestinal irritation. 

Treatme?it of Poisoning. — The indications are to empty the 
stomach, favor elimination, and treat the patient symptomatically 
by the use of demulcents, anodynes, stimulants, etc., as necessary. 

Therapeutics. — Exter?ially and Locally. — Tlie drug is a de- 
servedly popular remedy in many diseases of the nose and throat. 
The insufflation of an impalpable powder of cubeb or the inhala- 
tion of smoke from the burning drug is an efficient palliative to the 
sense of oppression arising from turgescence of the nasal mucous 
membrane. 



DIURETICS. 653 

The troches of cubeb are extensively used for coughs, hoarse- 
ness, etc. The oil of cubeb is used as an inhalant and as a local 
application in many diseases of the tliroat and respiratory passages. 

Internally. — Cubeb is used internally for about the same pur- 
poses as copaiba, although by many physicians considered to be 
inferior to the latter drug in genito-urinary disorders. 

The drug has been recommended in certain nervous disorders, 
such as headache, impaired memory, vertigo, and fainting, and has 
even been thought to prove beneficial in certain cases of paralysis. 

Contraindications. — The same as for copaiba. 

Administration. — Any of the preparations may be given. The 
oleoresin is best administered in capsules or emulsion. 

Diuretin— Diuretin— Diuretin. 

(SODIO-SALICYLATE OF THEOBROMINE.) 

Origin. — The name indicates the origin, the drug being a chemi- 
cal combination of Theobromine (49.7 per cent.) and Salicylic 
Acid (38.1 per cent.). It is, in reality^ a mixture of Theobron.ine 
and Sodium Salicylate. 

Description and Properties. — A white powder, soluble in less 
than half its weight of hot water, the solution remaining perfect on 
cooling. Sparingly soluble in cold water ; soluble in warm alco- 
hol ; insoluble in chloroform or ether. The drug has a disagree- 
able, soap-Hke taste, and undergoes decomposition when exposed 
to the air. 

Dose. — 15 grains (i.o Gm.) ; 45 to 105 grains (2.9-7.0 Gm.) 
may be given in divided portions in twenty-four hours. 

Antagonists and Incompatibles. — The properties of diuretin 
being as yet imperfectly known, it is impossible to enumerate all 
the antagonists, incompatibles, and synergists. The action of the 
drug would certainly be retarded by the cardiac and motor de- 
pressants. Acids, both mineral and vegetable, are incompatible. 

Synergists. — The therapeutic influence of the drug would 
theoretically be enhanced by caffeine, digitalis, and many of the 
cardiac stimulants and diuretics. 

Physiological Action. — Externally and Locally. — There is none. 

Internally. — Digestive System. — Diuretin has no important ac- 
tion, though in many cases it may cause disturbance of digestion, 
impair the appetite, and even occasion nausea, vomiting, and 
diarrhea. 



654 A TEXT-BOOK OF MA TERIA MEDICA. 

Circulatory System. — The drug has a very beneficial action 
upon the system in failing compensation and edema, its favorable 
influence being due to its effect upon the kidneys. Theobromine, 
like caffeine, exercises a direct, stimulating action upon the renal 
epithelium and also a stimulating effect upon the vaso-motor 
center in the medulla. While we should expect a marked diuretic 
action from the drug, such is not always the case, because of its 
vaso-motor influence in contracting the vessels of the kidney. The 
vaso-motor action, however, is remedied by the presence of the 
salicylate, leaving the blood-supply to the kidney increased, 
through the functional activity of the cells. 

Nei'vous System. — Large and continued doses frequently occa- 
sion headache, somnolence or insomnia, with buzzing in the ears, 
and symptoms resembling those produced by the salicylates. 

Respiratory System. — Diuretin exerts no direct influence upon 
the respiratory system. Yet dyspnea, bronchitis, etc., the result 
of a dropsical condition, are relieved by the administration of the 
drug. 

Absorption and Elimination. — Diuretin is somewhat rapidly ab- 
sorbed, being eliminated mainly by the kidneys, the process greatly 
stimulating the renal epithelium. It is proper to state, however, 
that some authors attribute the diuretic power of the drug to its 
action upon the circulation, rather than to any effect upon the 
secreting structures of the kidney. The author's experience leads 
him to incline to the opinion that the principal action of the drug 
is upon the kidneys. 

In cases where diuretin is indicated the amount of urine is 
increased from three- to sixfold in twenty-four hours, under its 
administration the diuretic action of the drug gradually reaching 
its maximum between the second and third days. In the case of 
healthy persons diuretin has little influence upon the amount of 
urine excreted. 

Untoward Action. — In certain individuals the drug causes great 
disturbance of the gastro-intestinal tract, such as nausea, vomiting, 
diarrhea, palpitation of the heart, headache, and shght fever ; occa- 
sionally cutaneous eruptions may be present. 

Poisoning. — No cases of poisoning are recorded. 

Therapeutics. — The drug is used exclusively as a diuretic in 
cases of dropsy, ascites, pleuritic effusion, etc. 

Diuretin is worthy of a thorough trial for the removal of drop- 
sical fluids, irrespective of the cause. 



DIURETICS. 655 

Dr. Herrick of Chicago, who has not only devoted much study 
to the Hterature of the subject, but has also had a wide experience 
with the remedy, in a recent paper on " Diuretin " sums up the 
medical uses of the drug as follows: 

'* Diuretin is a diuretic acting by direct stimulation of the renal 
epithelium, and best suited to cases in which there is general drop- 
sical effusio7i. It is the best medicinal remedy for removing drop- 
sical fluid due to valvular disease of the heart after digitalis and 
pure cardiac tonics have failed. Diuretin has oftentimes a bene- 
ficial effect in other circulatoiy diseases with dropsy, as myocarditis, 
pericarditis, aneiirysni, arteriosclerosis. Its action is here more 
uncertain than in valvular disease. In the dropsy of nephritis it 
can be used without danger of irritating the kidney, the effects in 
acute nephritis being more certain than in chronic nephritis. Where 
the renal epithelium has undergone too extensive degeneration the 
drug may fail to act. In the dropsy of portal obstruction, and 
especially of cirrhosis of the liver, it usually fails to give good 
results." 

Contraindications. — There are no special contraindications to 
the use of diuretin, unless it be in cases of marked gastric irritation, 
when the drug would undoubtedly aggravate the symptoms. 

Administration. — Diuretin may be given in capsules or dis- 
solved in some aromatic water or in milk. It should never be 
dispensed in powders, since it absorbs carbonic acid from the air 
and undergoes decomposition. 

It is preferable to give the drug in solution ; and it can be easily 
associated with digitalis and similar remedies, but when used with 
the cardiac remedies the doses of diuretin should be smaller. 

When giving this drug in cases of marked ascites, or for the 
removal of large quantities of dropsical fluid, the first doses should 
be small and gradually increased to the maximum amount or until 
the desired effect be produced, lest by a too sudden removal of the 
fluid alarming collapse ensue. 

As acids are incompatible with the drug, diuretin should not be 
given immediately after meals, but its administration postponed for 
about three hours, to avoid unpleasant symptoms arising from the 
action of the gastric juice upon the remedy. 

The practice of adding fruit syrups or juices to a solution of 
diuretin for the purpose of rendering it more palatable should be 
strictly avoided, since the theobromine is precipitated by the vege- 
table acids as a thick white sediment. 



656 A TEXT-BOOK OF MATERIA MEDICA. 

The maximum daily amount which can be safely administered 
is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 
grains (2.9-7.0 Gm,), given in divided doses of about 15 grains 
(i.o Gm.) each. 

If diuresis is not increased in six days, the use of the drug 
should be suspended and recourse to other treatment adopted. 

Piperazinum— PiperazTni— Piperazin. 

(Piperazidine; Ethyleneimine; Diethylenediamine; Dispermine.) 

Origin. — Obtained by the action of Ammonia on Bromide or 
Chloride of Ethylene. 

Description and Properties. — It occurs as a crystalline solid, 
exceedingly soluble in water, the solution being practically taste- 
less. When exposed to the air the drug is very deliquescent^ 
becoming completely liquefied on long exposure. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Antagonists and Incompatibles.^ — The incompatibles are alka- 
loids, tannic acid, preparations of cinchona, salts of iron, alum^ 
Donovan's solution, acetanilid, phenacetine, and sodium salicylate. 

Synergists. — Lithium and its salts and the hthontriptics enhance 
the therapeutic action of piperazin. 

Physiological Action and Therapeutics. — The drug apparently 
has no effect whatever upon either the Digestive, Circulatory, or 
Respiratory Systems. Excessive doses, however, have affected the 
Nervous System, producing certain untoward manifestations, such 
as muscular tremors, hallucinations, and clonic spasms. 

The drug is non-irritating when appHed to mucous membranes. 

Piperazin is rapidly absorbed from the stomach, circulates in 
the blood unchanged, and reaches the concretions of urates and 
gouty deposits, neutralizing and dissolving them, thus hastening 
their removal from the body. Piperazin may be detected in the 
urine two hours after ingestion. 

The only important action of piperazin is its property of dis- 
solving uric acid, with which it forms a neutral and exceedingly 
soluble salt, piperazin urate, said to be seven times more soluble in 
water than lithium urate. 

The superiority of piperazin over lithium carbonate as a uric- 
acid solvent has been indubitably established. 

Under the administration of piperazin there is an enormous in- 
crease in the amount of urea, with a corresponding decrease in the 
elimination of uric acid, indicating that there is active oxidation. 



DIURETICS. 657 

While greatly increasing the amount of urea eliminated, neither 
the volume of urine nor the acid reaction of that fluid is ordinarily- 
influenced. Moreover, while in certain cases diuresis is consider- 
ably augmented, the specific gravity of the urine is lowered, al- 
though the urine never becomes alkaline or even neutral. 

Therapeutics. — Externally and Locally. — A solution of pipera- 
zin (i to 2 per cent.) in a mixture of water and alcohol (i to 4, re- 
spectively) has been applied locally to gouty joints and swellmgs 
with beneficial results. A similar solution is equally effective in 
relieving the pain, allaying the inflammation, and hastening the 
healing of gotity sores. 

Solutions of piperazin may be injected into the bladder in order 
to dissolve vesical calculi. 

The drug has been recommended for local hypodermic injection 
in gout, although Wittsock, who used it in this manner consider- 
ably, claims that the subcutaneous administration of piperazin is 
painful and dangerous, causing inflammation with tendency to 
abscess. 

Internally. — Piperazin is one of the most useful remedies in gout. 
Its efficacy in this disease is said to be enhanced by combining 
with it phenocoU hydrochloride or phenacetin. 

Renal and vesical calculi of the uric-acid variety are dissolved 
by the free administration of piperazin. It has even proved bene- 
ficial in chronic cystitis and chronic rheumatic arthritis. 

Gruber has advocated the use of the drug in diabetes mellitus, 
and it has proved to be of service in renal colic and hematuria. 

It is in the uric-acid diathesis, however, that the drug is par- 
ticularly useful. The pruritus of this condition and other manifes- 
tations so frequently resulting from imperfect elimination of nitrog- 
enous material are promptly relieved by the internal administra- 
tion of this remedy. 

Contraindications. — None of importance can be named. 

Administration. — Piperazin is best given in aerated water, al- 
though it may be acceptably administered in distilled water and 
syrup, orange flower water, or other agreeable vehicle. 

Saccharinum—Saccharini— Saccharin. 

(Anhydro-ortho-sulphamin-benzoic Acid; Benzoyl-sulphonic-imide; Gluside; 

Glucusimide.) 

Origin. — A derivative of the aromatic series, prepared by a 
complicated process from Toluene. 
4?. 



658 A TEXT-BOOK OF MATERIA MEDIC A. 

Description and Properties. — A white, crystalline powder, of 
an acid reaction, a faint, amygdaloid odor, and an intensely sweet 
taste. One part of saccharin in 70,000 parts of water will impart 
to the solution a decidedly saccharine flavor, the drug being nearly 
300 times sweeter than cane-sugar. 

Saccharin is sHghtly soluble in water, i : 400 ; soluble in 30 
parts of alcohol ; and freely soluble in glycerin. The commercial 
article is usually very impure. 

Dose. — J-2 grains (0.03-0.12 Gm.). 

Physiological Action. — In a neutral or alkaline medium sac- 
charin acts as an antiseptic. Internally it exerts no notable influ- 
ence. It is said that when mixed with food it interferes with the 
action of saliva upon starch, and it is thought to retard the action 
of the other digestive ferments. The drug is not decomposed in 
the body, and is ehminated by the kidneys unchanged, increasing 
the amount of chlorides excreted in the urine, which fluid is so 
influenced by the drug that it does not so readily undergo fer- 
mentation. 

Therapeutics. — Externally and Locally. — Saccharin is used as 
a mouth-wash, being especially beneficial in apJithce. FeHci of 
Rome highly recommends the application of a solution of saccharin 
in ozena. 

Internally. — The principal use of the drug is as a substitute for 
sugar in cases of diabetes. 

Dr. James Little recommends saccharin in chronic cystitis with 
ammoniacal urine. 

The drug is extensively used in various elixirs, syrups, etc. to 
overcome the bitterness of quinine and other bitter alkaloids. 

Administration. — Saccharin should be given in solution. 



CATHARTICS. 659 

GROUP XIV.— CATHARTICS. 

Cathartics or Purgatives are substances which cause hurried 
evacuation of the bowels either by direct local irritation of the 
intestinal mucous membrane or by setting up an osmotic current 
from the tissues toward the lumen of the intestines, causing an 
accumulation of fluid in the bowels — in both cases causing in- 
creased peristalsis and watery or semisolid evacuations. 

Mechanism of Purgation. — It should be remembered that the 
epithelial surfaces through which the substances needful to the 
body enter it, and the waste-products leave it, are physiologically 
outside the body. The mucous membrane of the alimentary canal 
is in a sense as much external as the skin covering the surface of 
the body and is subject to the same irritating influences. The 
muscular mechanism of the intestines is somewhat peculiar in that 
it possesses the power to rhythmically contract and relax in a 
wave-like manner (peristalsis), the peristaltic waves travelling down- 
ward. These rhythmical movements of the intestines carry their 
contents .along their lumen from the cardia to the rectum, and are 
to a large extent independent of the central nervous system, 
although in a way controlled by a nervous mechanism. The nor- 
mal contents of the small intestine are fluid, and are passed into 
the large intestine as such. In their passage along the large 
bowel the fluid part is largely absorbed and the semisolid part 
remaining is passed on into the rectum as feces. 

In order that any substance may act as a purgative it must 
change the normal contents of the bowels in such a way as to 
cause fluid or semisolid evacuations. When a substance locally 
irritates the intestinal mucous membrane the intestines respond by 
increased peristalsis, which hurries the fluid contents of the small 
intestine through the large bowel so rapidly that absorption does 
not take place and the feces are evacuated in a fluid form. 

While increased peristalsis may be caused by action on the 
nervous mechanism of the intestines the exact modus opera7idi 
is imperfectly understood, and until the action of drugs on 
such mechanism is more thoroughly investigated we must as- 
sume that the action of purgatives is due chiefly to their local 
influence. 

Cathartics may be classified according to their various actions, 
the following table serving to show how and where the various 
drugs exert their several influences : 



66o 



A TEXT-BOOK OF MATERIA MEDICA. 



I. Classification according to their Mode of 

Laxatives. 
Cassia. 
Castor oil. 
Cascara sagrada. 

* Glycerin. 

* Magnesia. 

* Magnesium carbonate. 
Manna. 
Sulphur. 
Taraxacum. 

There are certain drugs 
which are not classed as 
cathartics, which are some- 
times prescribed by physi- 
cians as laxatives, such as — 
Belladonna.-^ 
Ergot.* 
Hyoscyamus.''^ 
Nux vomica.-^ 
Physostigma.* 
Stramonium.* 

Certain articles of diet are 
laxative, such as bran bis- 
cuit, brown bread, ginger- 
bread, oatmeal, figs, honey, 
molasses, prunes, raspber- 
ries, strawberries, tama- 
rinds, olive oil, etc. 



Action. 



Simple purgatives. 


Hydragogue purgatives. 


Drastic purgatives. 


Aloes. 


Croton oil (small 


Cathartic acid (hy 


Calomel.* 


doses). 


podermically). 


Cascara sagrada 


Elaterin. 


Colocynth. 


(full doses). 


Gamboge. 


Croton oil. 


Castor oil (full 




Elaterin. 


doses). 


Salines. 


Gamboge. 


Ox-gall. 


Magnesium citrate. 


Jalap. 


Rhubarb. 


Magnesium sulphate. 


Scammony. 


Euonymus. 


Potassium bitartrate.* 


Podophyllin 


Iris. 


Potassium sulphate. 




Juglans. 


Potassium tartrate.* 




Leptandra. 


Potassium and sodiurn 




Senna. 


tartrate. 
Sodium phosphate. 
Sodium sulphate. 





2. Classification according to their Manner of reaching the Intestinal 

Mechanism. 



By first contact. 

Nearly all the drugs used as cathartics. 



By circulation contact. By excretion contact. 



Morphine.* 


Aloes. 


Muscarine.* 


Castor oil. 


Physostigma.* 


Croton oil. 


Pilocarpine.* 


Colocynth. 


Strychnine.* 


Elaterium. 




Podophyllin 




Rhubarb. 




Senna. 



J. Conditions of the Intestines affecting the Action of Drugs. 

Drugs requiring the presence of Drugs requiring the presence Drugs not requiring the presence 



an alkali or bile to act. 
Aloes, 
Elaterium. 
Gamboge. 
Jalap. 



of an acid to act. 
Magnesium carbonate.* 
Magnesia.* 



of either alkali, bile, or acid. 
Castor oil. 
Colocynth. 
Croton oil. 
Euonymin. 



(Drugs marked with an asterisk (*) are here given in detail; others are described 
elsewhere.) 



CATHARTICS. 



66i 



Drugs requiring the presence of 
an alkali or bile to act. 

Scammony. 
Sulphur. 



Drugs not requiring the presence 
of either alkali, bile, or acid. 

Iris. 

Leptandra. 
Magnesium citrate. 
Magnesium sulphate. 
Podophyllin. 

Potassium and sodium tar- 
trate. 
Rhubarb. 
Senna. 
Sodium phosphate. 



^. Classification according to the Anatomical Portion of the Intestinal 
Canal on which they Act. 



Small intestine. 

Calomel.* 

Castor oil. 

Jalap. 

Leptandra. 

Podophyllin. 

Rhubarb. 

Scammony. 

Senna. 



Colon. 
Colocynth. 
Elaterium. 
Gamboge. 
Magnesium citrate. 
Magnesium sulphate. 
Potassium bitartrate.* 
Potassium sulphate. 
Potassium tartrate."^ 
Potassium and sodium tartrate. 
Sodium sulphate. 



Descending colon and rectum. 
Aloes. 



5. Classification of Cathartics according to Other Actions. 



Stomachics. 


Hepatic stimulants and 
cholagogues 


Galactagogues. 


Rendering the 

milk 

purgative. 


Increasing 

menstrual 

flow. 


Aloes. 


Aloes. 


Castor oil. 


Aloes. 


Aloes. 


Cascara sagrada. 


Colocynth. 




Castor oil. 




Euonymin. 


Colchicin. 




Rhubarb. 




Leptandrin. 


Euonymin. 




Senna. 




Iridin. 


Iridin. 




There are 




Rhubarb. 


Leptandrin. 
Podophyllin. 
Sodium phosphate. 
Sodium sulphate. 

Cholagogues. 




probably some 
other cathartics 
that affect the 
milk. 






Aloes. Mercury with chalk .* 








Calomel.* Pil.hydrargyri.* 










Colocynth. Podophyllin. 










Euonymin. Rhubarb. 










Iridin. 









(Drugs marked with an asterisk (*) are here given in detail; others are described 
elsewhere.) 



662 A TEXT-BOOK OF MA TERTA MEDICA. 

Intestinal peristalsis is increased probably by the stimulation 
of— 

1. The intestinal muscles (moderate stimulation); 

2. The afferent nerves connecting the intestinal mucous mem- 

brane with Auerbach's ganglia ; 

3. Auerbach's ganglia ; 

4. The ends of the efferent nerves passing from Auerbach's 

ganglia to the intestinal muscles ; 

5. The ends of the afferent nerves passing from the intestinal 

mucous membrane to the brain ; 

6. The motor centers in the brain ; 

7. The ends of the motor nerves terminating in Auerbach's 

ganglia. 
Depression of — 

8. The inhibitory motor center ; 

9. The ends of the inhibitory motor nerves terminating in 

Auerbach's gangha; 
10. The inhibitory motor center in the suprarenal plexus. 
It will be seen that any substance which stimulates the motor 
apparatus or depresses the inhibitory motor mechanism will increase 
peristalsis. 

Intestinal secretion may doubtless be promoted by any sub- 
stance which serves to stimulate the secretory or the vaso-dilator 
apparatus, or to depress the inhibitory secretory or vaso-constrictor 
mechanism. 

The methods by which absorption is diminished are not thor- 
oughly understood, but it is known that — 

I. By increasing peristalsis and hastening the removal of fluid 
from the bowels absorption takes place less rapidly ; 

2. By giving drugs — e. g. magnesium sulphate — having high 

osmotic equivalents, with a great affinity for water, the 
absorption of fluid is prevented ; 

3. Substances which in some manner affect the columnar 

epithelium of the intestinal glands retard absorption ; 

4. Drugs which diminish the circulation in the intestinal 

mucous membranes act as deterrents to the absorptive 
process. 
It is apparent that certain drugs produce various effects, and 
that their mode of action varies according to the size of the dose 
and occasionally with the idiosyncrasy of the patient. 

Nearly all cathartic drugs act by some local influence upon the 



CATHARTICS. 663 

intestinal mucous membranes previous to absorption ; others, again, 
affect the bowels after they have entered the circulation — strych- 
nine, for example, physostigmine, pilocarpine, etc., acting in this 
manner. 

Certain other drugs, such as podophyUin, colocynth, etc., if in- 
jected into the circulation are excreted by the mucous membrane 
of the intestines, and by their irritation produce catharsis. 

The condition of the intestinal canal has much to do with the 
activity of certain drugs. Thus certain medicines produce cathar- 
sis regardless of the reaction of intestinal fluids ; others are inert 
without the presence of bile or other alkaline fluids or salts ; and 
still a third class occasion catharsis only when after ingestion they 
come in contact with an acid. Of the last mentioned, magnesium 
carbonate is an excellent example, the drug being inert unless it be 
acted upon by an acid in the stomach or bowels. 

It is a remarkable fact that, as is shown in the tables, different 
cathartics act more energetically upon different portions of the in- 
testines. The action of calomel, for instance, is almost entirely 
confined to the duodenum, while aloes acts only upon the descend- 
ing colon and the rectum. 

In selecting a cathartic, therefore, a knowledge of the part of the 
intestinal canal to be acted upon and the locality in which the drug 
operates is necessary in order to secure the most satisfactory results. 

Many cathartics contain principles which render them tonic to 
the stomach ; others greatly stimulate the secretion of bile (hepatic 
stimulants) ; while the cholagogues merely hasten the expulsion of 
bile from the intestinal canal, preventing its absorption. 

Certain drugs, being excreted in the milk, which it renders 
purgative, are well adapted for administration to the nursing mother 
in order to produce catharsis in the infant. Castor oil, greatly 
augmenting the secretion of milk, is an excellent medium as a 
laxative in such cases. 

Aloes increases the menstrual flow ; other drugs promote the 
secretion of urine, etc. 

Therapeutics. — Cathartics are employed — 

1. To remove feces and produce a simple evacuation of the bowels. 
The Laxatives are best adapted for this purpose. 

2. For the relief of chronic constipation. For this purpose great 
judgment is requisite in the selection of a drug or combination of 
agents, it being important to determine whether there is diminished 
peristalsis or secretion ; whether there exists an atonic condition of 



664 ^ TEXT-BOOK OF MATERIA MEDICA. 

the intestinal muscles ; or whether the disorder is located in the 
small intestine, the colon, or the rectum. 

3. To remove from the bowels noxious substances or pathogenic 
matter. For this purpose the mercurial preparations, calomel or 
gray powder, are best, since they are not only active cathartics, but 
bactericides as well. 

4. To stimulate the torpid liver. For this purpose the hepatic 
stimulants would naturally be employed. 

5. To lessen the activity of the liver, as in bilious conditions. In 
such cases the cholagogue cathartics should be used. 

6. To deplete the g astro-duodenal mucous membrayie, where the 
congested and swollen mucous membrane obstructs the outflow of 
bile, resulting in jaundice. In this condition the saKnes, especially 
the sodium salts, are the most efficient cathartics. 

7. To promote absorption and remove dropsical effusions in cer- 
tain diseases of the heart, liver, and kidneys. Here active cathar- 
sis is necessary, the hydragogue cathartics being indicated. 

8. To remove urea, etc., from the blood. Occasionally in certain 
renal diseases the functional activity of the kidneys is so defective 
that waste matter, urea, etc., rapidly accumulates in the system, 
occasioning uremic convulsions, coma, or other serious symptoms. 
In such cases it may be necessary to give a drastic purgative, such 
as croton oil, which acts rapidly, causing profuse watery stools. 

9. To lower the blood-pressure where high arterial tension aggra- 
vates a malady, as at the onset of many acute diseases, and in 
cerebral hemorrhage, meningitis, etc. In these conditions it is 
necessary to employ such drugs as, by dilating the intestinal blood- 
vessels, drain the blood away from other organs and cause abun- 
dant watery discharges from the bowels. Hydragogue or drastic 
purgatives answer the required purpose. 

10. For the relief of hemorrhoids, in which cases the mild laxa- 
tives, such as sulphur, senna, etc., are serviceable. 

11. To aid the restoration of the catamenia. For this purpose 
aloes is usually employed, particularly if it be necessary to deter- 
mine more blood to the pelvic organs. If depletion be required, 
the selection should be made from the hydragogue cathartics. 

12. To purge the nursing infant through the mother's milk. For 
this purpose such drugs as rhubarb, senna, and castor oil may be 
administered to the mother. 

13. To lower the temperature in fever, in which cases the saline 
cathartics may be advantageously employed. 



CATHARTICS. 665 

Contraindications. — Activ^e catharsis by the more powerful 
hydragogue or drastic purgatives would be contraindicated in ap- 
pendicitis, peritonitis, typhlitis, intussusception, pregnancy, and 
typhoid fever, or where there is inflammation of the mucous mem- 
brane of the gastro-intestinal tract. 

Administration. — Probably no group of medicines demands 
greater judgment in administration than Cathartics. 

Ordinarily, the efficiency of these agents is increased and their 
operation rendered less irritant by associating drugs acting upon 
different portions of the alimentary canal. Their action, too, is 
more prompt and certain when the remedies are given upon an 
empty stomach and the efficiency of their operation is enhanced 
by exercise and diminished by sleep. 

The action of cathartics is promoted by the addition of small 
doses of emetics, mydriatics, quinine, and bitters, quinine especially 
strengthening the action of magnesium sulphate. Mild diluent 
beverages also promote the activity of cathartics. Cold applied 
to the abdomen, enemata, massage of the abdominal walls, and 
electricity, all act as adjuvant measures in the employment of 
purgative medicines. 

As has been previously suggested, a knowledge of the portion 
of the intestinal canal upon which the various cathartics act is of 
primary importance. Thus, if it be necessary to influence only 
the duodenum, calomel or podophyUin should be used ; if the 
small intestine, senna or jalap ; if the descending colon or rectum, 
aloes, — the drugs acting upon these organs alone. 

Moreover, due consideration should be given to the proper time 
for the administration of the different cathartics, the resinoid pur- 
gatives acting best when taken at night or before dinner, and the 
salines when taken in the morning before breakfast. 

The mode of administration is also of great importance, in 
order to obtain from these agents the fullest benefit. The salines, 
for instance, act best when given in solution in either very cold or 
very hot water, their activity being enhanced by association with 
bitters, iron, or sulphuric acid. On the other hand, the resinoid 
drugs should be administered in the form of pills, and if, for any 
reason, it is desirable that the drug should enter the intestine with- 
out coming in contact with the mucous membrane of the stomach, 
the drug may be given in the form of pills coated with keratin, 
which is unaffected by the gastric juice, but readily dissolved in 
the alkaline intestinal juices. 



666 A TEXT-ROOK OF MA TERIA MEDICA. 

In the following detailed description cathartic drugs are grouped 
according to their modus operandi^ the mildest drugs or laxatives 
being first considered. 

LAXATIVES. 

Certain substances never produce active purgation, but simpl)r 
unload the bowels by slightly increasing both peristalsis and secre- 
tion, expelling the feces in a softened though solid and formed 
condition, without irritation and without perceptibly affecting the 
general system. 

These agents are especially useful where we wish to evacuate 
the bowels with the least possible local derangement, as in simple 
constipation from dyspepsia, in children, pregnant women, con- 
valescents from acute disease, or patients affected with hemorrhoids,, 
hernia, affections of the rectum or womb, typhoid fever, early 
simple diarrhea, or in inflammation or surgical operations about 
the abdomen and pelvis. 

Besides the laxative drugs mentioned below there are many 
articles of diet which by purely mechanical action produce 
catharsis, such as oatmeal, brown bread, whole flour, molasses^ 
prunes, figs, etc. 

Cassia Fistula— Cassiae Fistulae— Cassia Fistula. 

(Purging Cassia.) 

Origin. — The fruit of Cassia Fistula L., a tree 30 to 50 feet 
(9-15 M.) high, indigenous in the East Indies. 

Description and Properties. — Cylindrical, i|^ to 2 feet (45-60 
Cm.) long, nearly i inch (25 Mm.) in diameter, blackish-brown, 
somewhat veined, the sutures smooth, forming two longitudinal 
bands ; indehiscent, internally divided transversely into numerous 
cells, each containing a reddish-brown, glossy, fl.attish-ovate seed 
imbedded in a blackish-brown sweet pulp ; odor resembling that 
of prunes. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 
ConfSctio SSnnae — Confectionis SSnnae — Confection of Senna. — Described 
under Senna, p. 681. 

Physiological Action and Therapeutics. — Cassia is a mild and 
pleasant laxative. It is seldom given alone, however, but forms an 
ingredient in the confection of senna. 



CATHARTICS. 667 

Oleum Riclni— Olei Ricini— Castor Oil. V. S. JP. 

Origin. — A fixed oil expressed from the seed of Ricinus com- 
munis L., a plant indigenous in Southern Asia and cultivated in 
temperate countries for ornament and other purposes, remaining- 
a large annual. 

Description and Properties. — A pale-yellowish or almost color- 
less, transparent, viscid liquid, having a faint, mild odor and a 
bland, afterward slightly acrid and generally offensive taste. Solu- 
ble in an equal volume of alcohol and in all proportions in abso- 
lute alcohol. Castor oil should be kept in well-stoppered bottles. 

Dose. — |— 2 fluidounces (8.0-60. Cc.) 

Physiological Action. — Externally and Locally. — Castor oil — 
like other bland fixed oils, such as almond oil, olive oil, etc. — is 
sedative and protective when applied to the skin or mucous 
membranes. 

Internally. — The only important action is upon the intestinal 
tract, on which the oil acts as a mild irritant, causing purgation. 
Chemically castor oil is a combination of glycerin, fatty acids, and 
ricinoleic acid. This combination passes the stomach unchanged, 
but in the presence of the bile and pancreatic juice it is broken up 
into glycerin and ricinoleic acid; the ricinoleic acid combines with 
sodium and forms sodium ricinoleate, which has marked irritating 
properties. The ricinoleate of sodiumx is absorbed and excreted in 
various ways, appearing in the mother's milk and imparting to it 
purgative properties. 

Castor oil requires from four to six hours to operate, its action 
being usually attended with little pain. Indeed, the author is 
inclined to attribute anodyne properties to the drug, since it has 
frequently occurred to him in practice that a dose of castor oil 
given to a child suffering with colicky pains, while producing no 
movement of the bowels, served to allay the distress and cause 
the patient to sink into a quiet sleep. 

The poisonous principle, ricine, found in castor beans is an albu- 
minous substance belonging to the globulin group, and is generally 
termed a toxglobulin. Ricine is one of the most powerful poisons 
known, but being insoluble in oil and soluble in water it is not 
present in expressed castor oil. The symptoms of poisoning from 
castor beans are violent abdominal pain, vomiting, purging, and 
collapse. Post-mortem examinations have revealed evidences of 
severe inflammation in the stomach and intestines. 



668 A TEXT-BOOK OF MA TERIA MEDICA. 

Castor oil should not be used as an habitual laxative, its con- 
tinual employment being liable to occasion constipation with all 
its attendant evils. 

Therapeutics. — Castor oil is used alone or associated with bal- 
sam of Peru as a sedative protectant dressing for superficial ulcera- 
tions. The drug is also serviceable in various diseases of the skin 
and mouth. 

It is probably superior to all other laxatives, and is applicable 
to all conditions for which laxatives are employed. In large doses 
it is one of the best purgatives to give in conjunction with an 
anthelmintic. 

Administration. — The unpleasant taste of castor oil is the only 
objection to its use. Yet it can be rendered quite palatable by 
mixing it with an equal quantity of glycerin, to which may be 
added a few drops of oil of cinnamon or oil of wintergreen. 

Various other devices for disguising the taste have been adopted, 
such as enveloping the oil in the froth of beer, ale, or porter, or 
washing out the mouth with brandy or whiskey previous to admin- 
istration, and allowing the patient to swallow the oil quickly, when 
it will not adhere to the mouth and fauces, especially if followed 
by a drink of some alcoholic liquid. 

In the form of an emulsion the taste of the oil is well disguised. 
There are also soft capsules of castor oil which are of course taste- 
less, yet they are too bulky to be popular. 

Castor-oil emulsion may be used as an enema when a mild 
injection is required. 

Rhamnus Purshiana— Rhamni Purshianae— Cas- 
cara Sagrada. JJ. S. JP, 

Origin. — The bark of Rhamnus Purshiana D. C, a shrub or 
small tree 15 to 20 feet (4.5-6 M.) high, indigenous on the Pacific 
coast of North America from the British possessions southward to 
Northern Cahfornia. 

Description and Properties. — Quills or curved pieces about 
^ to 4 inches (3-10 Cm.) long and about -^ inch (2 Mm.) thick; 
outer surface brownish-gray and whitish, the young bark with 
numerous, rather broad, pale-colored warts ; inner surface yellow- 
ish to light brownish, becoming dark brown with age ; smooth or 
finely striate, fracture short, yellowish, in the inner layer of thick 
bark somewhat fibrous ; inodorous ; taste bitter. 

The bark contains red, yellow, and brown resins, tannic, malic. 



CATHARTICS. 669 

and oxalic acids, a volatile oil, and a neutral, crystalline sub- 
stance. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 

Official Preparation. 
Extractum Rhamni Purshianae Fluidum— Extract! Rhamni Purshianse 
Fluid! — Fluid Extract of Rhamnus Purshiana. — Dose, %-\ fluidrachm (1.0-40 
Co.). 

Unofficial Preparations. 

Certain pharmaceutical chemists, in order to overcome the bitter taste of cascara 
have devised various preparations, such as — 

Cascara Cordial. 

Aromatic Fluid Extract of Cascara. 

Elixir of Cascara, etc. 

Messrs. Parke, Davis & Co. of Detroit offer a concentrated preparation of the drug, 
kiiown as Cascarin, which is almost tasteless and soluble in water. Dose, %-yz grain 
(0.01-0.03 Gm.). 

Physiological Action. — Cascara sagrada is a peculiarly efficient 
laxative, although in certain individuals it appears to be inert unless 
associated with other purgatives. The bitter principle it contains 
gives to the drug stomachic properties, and it is also said to stimu- 
late slightly the functional activity of the liver. 

The action of cascara is seldom attended with irritation or un- 
pleasant symptoms, the drug requiring from six to ten hours to 
operate. 

Therapeutics. — Cascara is a very valuable laxative, being em- 
ployed chiefly to overcome habitual constipation due to simple tor- 
por of the colon without associated disease. The drug is not 
adapted for rapid evacuation of the bowels, but rather for regulating 
their action. 

Administration. — The fluid and solid extracts are usually em- 
ployed, although the cascara cordial and the aromatic fluid 
extract, while requiring larger doses, are so palatable that they 
have become deservedly popular. 

Whatever be the preparation used in cases of habitual consti- 
pation, it should be given in small but repeated doses, gradually 
diminished until a natural action of the bowels shall have been 
established. The drug should be administered upon an empty 
stomach and in as diluted a condition as possible. 

Magnesia— Magrnesiae— Magnesia. TJ. S. J*. 

(Light Magnesia; Calcined Magnesia.) 
Origin, description, and properties given under "Alkalies," p. 156. 
Dose. — 5-60 grains (0.32-4.0 Gm.). 



670 A TEXT-BOOK OF MATERIA MEDICA. 

Magnesii Carbonas— Mag-nesii Carbonatis— Mag- 
nesium Carbonate. 17. S. JP. 

Origin, description, and properties given under " Alkalies," p. 

156. 

Dose. — \-2 drachms (1.0-8.0 Gm.). 

Physiological Action. — Both magnesia and magnesium car- 
bonate are mild antacid laxatives, requiring the presence of an 
acid in the stomach and bowels to render them active. Occasion- 
ally, when there is marked acidity of the stomach, magnesium 
carbonate occasions flatulence. 

When taken in large amounts or for a long time magnesia tends 
to accumulate in the intestines. This untoward effect may be pre- 
vented by administering with the drug lemonade, the acid of which 
increases the solubility of the magnesia. 

Therapeutics. — Magnesium carbonate as a protective powder 
is an effective agent in the treatment of dermatitis of the external 
auditory passage. The drug is a valuable antidote to counteract 
the effects of phosphorus-poisoning in the throat. 

Both MAGNESIA and magnesium carbonate are mild alkalies, 
and may be used for the same purposes as the alkalies. They are 
serviceable antidotes to poisoning from mineral and oxalic acids 
and many mineral salts. They are pleasant laxatives, being ex- 
tensively employed for children. 

Manna— Mannae— Manna. TI.S.B. 

Orig-in. — The concrete, saccharine exudation of Fraxinus Ornus 
L., a slender tree indigenous on the northern shore of the Mediter- 
ranean from Asia Minor west to Spain. 

Description and Properties. — Flattish, somewhat three-edged 
pieces, about 8 inches (20 Cm.) long and 2 inches (5 Cm.) broad 
(usually smaller), friable, externally yellowish-v/hite, internally 
white, porous, and crystalline ; or fragments of different sizes, 
brownish-white and somewhat glutinous on the surface, internally 
white and crystalline ; odor honey-like ; taste sweet, slightly bitter, 
and faintly acrid. Manna contains a resin, the purgative principle, 
besides mannite, fraxin, and sugar. 

Dose. — ^-i ounce (16.0-32.0 Gm.), dissolved in hot water. 

Official Preparation. 

Infusum SSnnae Comp6situm — Infusi SSnnae Comp6siti— Compound Infu- 
sion of Senna. — See Senna, p. 68i. 



CATHARTICS. 671 

Physiolog-ical Action and Therapeutics, — Manna is a laxative, 
cholagogue, and nutrient. Its mild laxative action renders the 
drug peculiarly efficient in constipated conditions of pregnant 
women, and children and persons suffering from piles or irritation 
x)f the genito-nrinary tract. 

The drug is slow in its action, tending to confine the bowels 
after the primary laxative effect. 

Sulphur Sublimatum— Sulphuris Sublimati— Sub- 
limed Sulphur. JJ. S. J>. 

Orig-in. — Obtained from Crude Sulphur by sublimation. 

Description and Properties. — A fine yellow powder, having a 
slight characteristic odor and a faintly acid taste. Insoluble in 
water; slightly soluble in absolute alcohol; more readily soluble 
in benzin, benzol, oil of turpentine and many other oils, as well as 
in ether, chloroform, and boiling aqueous solutions of alkaline 
hydrates. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Sulphur Lotum — Sulphuris Loti — Washed Sulphur. — Origin. — Sublimed Sul- 
phur, loO; Water, 100 ; Ammonia Water, lO; digested, filtered, drained, and dried. 

Description and Properties. — A fine yellow powder without odor or taste. Insoluble 
in water, but soluble in the substances which dissolve sulphur. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

UnguSntum Siilphuris — Ungu6nti Stilphuris — Sulphur Ointment. — Washed 
Sulphur, 300; Benzomnted Lard, 700. For external use. 

Washed sulphur is an ingredient of compound liquorice powder. 

Sulphur Praecipitatum— Sulphuris Praecipitati— 
Precipitated Sulphur. L\ S, P, 

(Milk of Sulphur; Lac Sulphur.) 

Origin. — Sublimed Sulphur is boiled with Slaked Lime and 
Water. To the solution is added Hydrochloric Acid, which throws 
down Sulphur as a fine precipitate, the powder being washed and 
-dried. 

Description and Properties. — A fine amorphous powder of a 
pale-yellow color, without odor or taste. Insoluble in water. 

Dose. — 15-60 grains (i. 0-4.0 Gm.). 

Physiological Action. — Externally and Locally. — Sulphur is an 
active parasiticide, antiseptic, and keratoplastic agent. Upon the 
skin the drug of itself has no influence ; a portion of it, however, 



672 A TEXT-BOOK OF MA TERIA MEDICA. 

is converted into hydrogen sulphide, which acts as a mild cutane- 
ous irritant. 

Internally. — As observed, sulphur proper has no action either 
externally or locally, although it is a normal constituent of nearly 
all the soHds and fluids of the body. When ingested some of it 
is converted into hydrogen sulphide and other sulphides, which 
increase the intestinal secretions and promote peristalsis. 

The drug is chiefly excreted with the stools, which are rendered 
soft and semi-liquid. A portion of the hydrogen sulphide formed 
is eliminated through the kidneys, lungs, skin, and milk-glands. 
The drug is usually found in the urine as sulphate. 

There is imparted to the breath the offensive odor of hydrogen 
sulphide, and the minute portion eliminated through the skin is suf- 
ficient to discolor silver ornaments in contact with the body-surface. 

While hydrogen sulphide is a powerful poison, decomposing 
the blood and paralyzing the nervous and muscular systems, the 
amount formed and absorbed under the administration of sulphur 
is too small to produce marked toxic symptoms, even when large 
amounts of sulphur have been ingested, there is produced only 
violent vomiting and purging, a slight elevation of temperature^ 
and a distinct odor of hydrogen sulphide in the breath. 

When sulphur is used in full doses for a long time, it tends to 
impair the quality of the blood and produce muscular weakness. 
Occasionally untoward manifestations, such as miliary eruption and 
eczema, accompany either the external appHcation or the ingestion 
of the drug. 

As a laxative sulphur is slow and mild, although it occasionally 
causes considerable flatus, in some cases rendering the drug objec- 
tionable as a purgative. 

Therapeutics. — Externally and Locally. — While classed among 
laxative drugs, sulphur is a most efficient remedy in many diseases 
of the skin^ nose, throat, etc., the external uses of sulphur being 
very numerous. 

The drug is perhaps the most serviceable parasiticide we possess 
in scabies, sulphur ointment well rubbed into the skin being usually 
sufficient to destroy the parasite. 

Even diseases induced by vegetable parasites, such as tinea 
versicolor, etc., are cured by inunctions of sulphur ointment. 

The drug is successfully employed in the treatment of infil- 
trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. 

The flowers of sulphur is an old domestic remedy, and quite 



CATHARTICS. 673 

an efficient one, in diphtheria and pharyngitis. Finally, Coroden 
and Duchane have both reported the successful treatment of 
sciatica by enveloping the affected limb in precipitated sulphur, 
the profuse sweating induced being followed by a decided allevi- 
ation of pain. 

When SULPHUR is burned sulphur dioxide is formed, a powerful 
germicide. By the fumes rooms and clothing may be disinfected, 
fumigation by sulphur being a common procedure to destroy 
the germs of typhoid fever, tuberculosis, cholera, diphtheria, small- 
pox, etc. 

Internally. — The principal internal use of sulphur is as a mild 
laxative, the drug being especially indicated for persons afflicted 
with hemorrhoids or anal fissure. 

Lozenges are prepared containing sulphur and cream of tartar, 
which, if taken daily for some time, will overcome habitual consti- 
pation, being especially serviceable in constipation due to disease 
of the liver. 

Sulphur has been used internally, and occasionally with con- 
siderable success, in bronchitis, chronic rheumatism, and eczema 
attended with much itching. 

Administration. — Sulphur may be given in the form of loz- 
enges or mixed with molasses — either alone or associated with cream 
of tartar, which is said to enhance the action of sulphur. Milk 
and syrup have been used as vehicles in the administration of the 
drug. 

Sulphurous baths, both natural and artificial, have been em- 
ployed in the treatment of rheumatism, gout, and some cutaneous 
affections. Not only for these purposes, but for their laxative 
influence as well, sulphurous waters are held in great repute. 

Taraxacum— Taraxaci— Taraxacum. TJ* S. B. 

(Dandelion.) 

Origin. — The root of Taraxacum officinale Weber, a perennial, 
acaulescent herb found in most countries of the northern hemi- 
sphere. 

Description and Properties. — Slightly conical, about 1 2 inches 
(30 Cm.) long and \ to I inch (12-25 Mm.) thick above, crowned 
with several short, thickish heads, somewhat branched, dark brown, 
longitudinally wrinkled ; when dry breaking with a short fracture, 
showing a yellowish, porous central axis surrounded by a thick, 
4.3 



674 ^ TEXT-BOOK OF MATERIA MEDIC A. 

white bark containing numerous milk-vessels arranged in con- 
centric circles; inodorous; bitter. 

The drug contains a bitter principle, taraxacin, besides inulin^ 
resin, sugar, and mucilaginous substances. 

Dose. — 1-4 drachms (4.0-15.0 Gm.). 

Official Preparations. 

BxtrSctum Taraxaci — Extract! TarSxaci— Extract of Taraxacum. — Dose, 
5-60 grains (0.3-4.0 Gm.). 

Extr^ctum Tar^xaci Fluidum — Extract! TarSxaci Fluidi — Fluid Extract 
of Taraxacum. — Dose, 1-4 fluidrachms (4.0-15.0 Cc). 

Physiological Action and Therapeutics. — Taraxacum is a 
stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic 
stimulant. It has been a popular remedy for constipation associated 
with hepatic congestion and atonic dyspepsia, yet the drug is now less 
employed than formerly, in actual practice being usually united 
with other laxatives. 

The extract or fluid extract may be given, the latter and the 
expressed juice being the more active. 

SIMPLE PURGATIVES. 

These differ from laxatives only in degree, the former being 
more active, exciting greater peristaltic action and causing a larger 
secretion from the intestinal glands. Simple purgatives usually oc- 
casion one or more copious and somewhat liquid stools, frequently 
accompanied by considerable irritation and griping. 

Aloe— Aloes— Aloes. TJ. S. J*. 

Origin. — The inspissated juice of the leaves of Aloe (A. vera 
(L.) Webb; A. Perryi Baker), a plant resembling the so-called 
century plant {Agave Americana), indigenous in India and North- 
eastern Africa, and naturalized along the shores of the Mediter- 
ranean and in the West Indies. 

Official Varieties. 

Aloe BarbadSnsis — Aloes BarbadSnsis — Barbadoes Aloes (CuRAgoA 
Aloes). — Origin. — Prepared from Aloe vera. 

Habitat. — Island of Barbadoes. 

Description and Properties. — Hard masses, orange-brown, opaque, translucent on 
the edges; fracture waxy or resinous, somewhat conchoidal; odor saffron-like; taste 
strongly bitter. 



CA THAR TICS. ^75 

Dose. — ^~^° grains (0.03-0.6 Gm.), 

Aloe Socotrina— Aloes Socotrinae — Socotrine Aloes. — Origin. — Obtained from 
Aloe Perryi. 

Habitat. — Island of Socotra in the Strait of Bab-el-Mandeb. 

Description and Properties. — Hard masses, occasionally soft in the interior, opaque, 
yellowish-brown, orange-brown, or dark ruby-red, not greenish, translucent on the edges ; 
fracture resinous, somewhat conchoidal. When breathed upon it emits a fragi'ant, saf- 
fron-like odor. Taste peculiar, strongly bitter. Almost entirely soluble in alcohol and 
in 4 parts of boiling water. The aqueous solution becomes turbid on cooling and yields 
a deposit. Examined under the microscope, Socotrine aloes exhibits numerous crystals. 

The active principle of the various Aloes is aldin, a neutral prin- 
ciple, varying in chemical composition and physical properties 
according to the species from which it is derived ; thus the sub- 
stance from Barbadoes aloes (barbaloin) is soluble in 60 parts of 
water, 20 parts of alcohol, and 470 parts of ether ; that from Soco- 
trine aloes (socalo'in) is soluble in 60 parts of water, 30 parts of 
absolute alcohol, and 380 parts of ether. 

Nataloin, obtained from the unofficial Cape aloes, may be distinguished from the 
■official aloin by heating the former with a drop or two of sulphuric acid and exposing it 
to the vapor of nitric acid, when nataloin changes to a blue color; barbaloin and soca- 
loin are unaffected by this test. Nitric acid applied to barbaloin gives a crimson color, 
which rapidly fades ; the crimson color imparted to nataloin is permanent, while no 
•color is produced when nitric acid is applied to socaloin. 

Dose. — J-io grains (0.03-0.6 Gm.). 

Official Preparations. 

Extractum Aloes — Extracti Aloes — Extract of Aloes. — Dose, J-6 grains 
{0.03-0.4 Gm.). 

Aloe Purificata — Aloes Purificatse — Purified Aloes. — Dose, |-io grains (0,03- 
0.6 Gm.). 

ExtrSctum Colocynthidis Comp6situm — ExtrScti Colocynthidis Comp6siti 
— Compound Extract of Colocynth. — Dose, 5-25 grains (0.3-1.6 Gm.). 

The following official preparations are prepared from purified aloes : 

Pilulae Aloes— Pilulas (ace.) Aloes— Pills of Aloes.— Z>d7^^, i to 4 pills. 

Pilulae Aloes et Asafoetidae — Pilulas (ace.) Aloes et Asafcetidae — Pills of 
Aloes and Asafetida. — Each pill contains about li grains (0.085 Gm.) of each. — 
Dose, I to 5 pills, 

Pilulae Aloes et Fferri— Pilulas (ace.) Aloes et Fgrri— Pills of Aloes and 
Iron.— Each pill contains about i grain (0.06 Gm.), each, of Aloes, dried Ferrous Sul- 
jjhate, and Aromatic Powder. — Dose, I to 4 pills. 

Pilulae Aloes et MSstiches— Pilulas (ace.) Aloes et Mastiches— Pills of 
Aloes and Mastich.— Each pill contains about 2 grains (0,12 Gm.), together with 
Mastich and Red Rose. — Dose, i to 3 pills. 

Pilulae Aloes et Myrrhae— Pilulas (ace.) Aloes et Myrrhae- Pills of Aloes 
and Myrrh.— Each pill contains 2 grains (0.12 Gm.), together with Myrrh and Aromatic 
Powder. — Dose, I to 3 pills. 



676 A TEXT-BOOK OF MATERIA MEDICA. 

Pilulae Rhei Comp6sitae — Pilulas (ace.) Rhei CompSsitas— Compound Pills 
of Rhubarb. — Each pill contains i grain (0.06 Gm.) of Aloes.— ZJ^^-^, i to 3 pills. 

Tinctiira Aloes — Tincturae Aloe? — Tincture of Aloes (10 per cent.). — Dosty 
\-\ fluidrachm (2.0-4.0 Cc). 

Tinctura Aloes et Myrrhae — Tincturae Aloes et Myrrhae— Tincture of Aloes 
and Myrrh (10 per cent, of each, with Glycerin 10 per cent.). — Dose, \-2\ fluidrachms 
(2.0-10.0 Cc). 

Tinctura Benzoini Compdsita — Tinctiirae Benzoini Comp6sitae — Compound 
Tincture of Benzoin (2 per cent, of Aloes). — Dose, 10-40 minims (0.6-2.6 Cc). 

Aloinum — Aloini — Aloin. U. S. P. — Origin. — A neutral principle obtained from 
several varieties of Aloes. 

Description and Properties. — Minute, acicular crystals, or a micro-crystalline pow- 
der, varying in color from yellow to yellowish-brown ; odorless or possessing a sHght 
odor of aloes, of a characteristic, bitter taste, and permanent in the air. The solubilities 
of barbaloln and socalo'in are given above. 

Dose. — \-2 grains (0.03-0.12 Gm.). 

Physiolog-ical Action. — Aloes has no local action, although 
the drug is readily absorbed from ulcers or abraded surfaces. 

Internally, it is stomachic, increasing the secretions from the 
gastro-intestinal tract. It probably increases the secretion of bile. 
Its principal action appears to be upon the colon, the muscular 
coat of which it stimulates, besides augmenting the secretion from 
the large intestine. 

In from ten to fifteen hours after the ingestion of the drug it 
causes soft, dark-colored evacuations, its action being usually 
attended with more or less griping pain. 

The blood-supply to the lower bowel and pelvic viscera is 
increased by aloes ; and the drug, if used habitually, may bring 
on or aggravate hemorrhoids. The menstrual function is stimu- 
lated, the drug being quite a decided emmenagogue. 

Aloes is readily absorbed ; it is thrown off through the bowels 
and kidneys, and is found also in the milk. 

Therapeutics. — The principal use of aloes is as a purgative in 
habitual constipation due to a torpid condition of the large intestine. 
Jaundice resulting from hepatic congestion is well treated with 
aloes and blue pill. 

Pills of aloes and iron are useful adjuvants to other remedies 
in the treatment of chlorosis. Amenorrhea, which is such a common 
condition in chlorosis, is relieved by aloes. Pills of aloes and iron 
are equally valuable in menorrhagia arising from debihty. 

Contraindications. — Aloes is ordinarily contraindicated in hem- 
orrhoids, although those cases attended with a mucous discharge 
are frequently benefited by it. The drug is considered objection- 



! 



CATHARTICS. 677 

able in pregnancy, in persons of plethoric, bilious, or hemorrhagic 
constitution, and in menorrhagia of the strong and full-blooded. 

Administration. — When desired as a purgative, aloes in pill 
form is preferable to the liquid preparations, and the drug may 
be given alone or associated with other purgatives, tonics, or 
antispasmodics. 

Aloin is perhaps to be preferred to aloes, as it gripes less and 
may be given in smaller doses. 

As a purgative aloes ranks between rhubarb and senna. 

Fel Bovis— Fellis Bovis— Oxgall. 77. H, :P. 

(Fel Tauri.) 

Origin. — The fresh bile of Bos Taurus L; 

Description and Properties. — A brownish-green or dark-green, 
somewhat viscid liquid, having a peculiar, unpleasant odor and 
a disagreeable, bitter taste. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Official Pre palpation. 

F61 Bovis Purificatum— FSllis Bovis Purificati— Purified QyigoW.— Descrip- 
tion and P)'ope7'ties. — A yellowish-green, soft. solid, having a peculiar odor and a partly 
sweet and partly bitter taste. Very soluble in water and in alcohol. 

Dose. — 5-15 grains (0,3-1.0 Gm.). 

Physiological Action and Therapeutics. — Like bile, oxgall 
augments the duodenal secretions, emulsionizes fats, and increases 
intestinal peristalsis. The drug Hquefies the bile, and acts as a 
cholagogue and purgative. It is a useful cathartic when the stools 
are very offensive and of a Hght clay color, indicating a deficient 
biliary secretion. The drug is serviceable in jaundice due to 
obstruction of the common duct by inspissated bile or mucus. 
Impacted feces are readily removed by an enema containing 1 5 or 
20 grains (i. 0-1.3 Gm.) of oxgall. The drug is an efficient intes- 
tinal antiseptic, and may be beneficially employed for that purpose 
in typhoid fever and intestinal fermeittation. 

Oxgall is usually given in pill form. 

Rheum— Rhei— Rhubarb. 77. >S^. J>. 

Origin. — The root of Rlieuni officinale Baillon, a plant indigen- 
ous in the western and northwestern portions of China. 

Description and Properties. — In cylindrical, conical, or flattish 



678 A TEXT-BOOK OF MATERIA MEDIC A. 

segments, deprived of the dark-brown, corky layer, smoothish or 
somewhat wrinkled, externally covered with a bright yellowish- 
brown powder, marked with white, elongated meshes, containing 
a white, rather spongy tissue, and a number of short, reddish- 
brown or brownish-yellow striae ; compact, hard ; fracture uneven ; 
internally white, with numerous red, irregularly-curved, and inter- 
rupted medullary rays, which are radially parallel only near the 
cambium line ; odor somewhat peculiar, aromatic ; taste bitter, some- 
what astringent. When chewed, rhubarb feels gritty between the 
teeth and imparts a yellow color to the saliva. Rhubarb which 
is very porous, or has a prominently mucilaginous taste, or is of 
a dark-brown color internally, should be rejected. 

The drug contains the following constituents : chrysophan 
(and chrysophanic acid), emodin, aparetin, phaeoretin, erythroretin, 
rheumic acid, and rheotannic acid, besides starch, calcium oxalate, 
etc. 

Dose. — 5-30 grains (0.32-1.94 Gm.). 

Official Preparations. 

ExtrSctum Rhei — Extract! Rhei — Extract of Rhubarb. — Dose, 3-15 grains 
(0.19-1.0 Gm.). 

Extractum Rhei Fluidum— Extract! Rhei Fluidi— Fluid Extract of Rhubarb 

(this preparation is used in Mistura Rhei et Sodge and in Syrupus Rhei). — Dose, 5-30 
minims (0.3-2.0 Cc). 

Pilulae Rhei — Pilulas (ace.) Rhei — Pills of Rhubarb. — Each pill contains 3 
grains (0.19 Gm.). Dose, I to 5 pills. 

Pilulae Rhei CompSsitae — Pilulas (ace.) Rhei CompSsitas — Coinpound 
Rhubarb Pills. — Each pill contains about 2 grains (0.12 Gm.) of Rhubarb, with puri- 
fied Aloes \]^ grains (0.09 Gm.), Myrrh, and Oil of Peppermint. Dose, i to 3 pills. 

Ptilvis Rhei CompSsitus — Ptilveris Rhei Comp6siti — Compound Rhubarb 
Powder (Gregory's Powder) — (25 per cent., with Magnesia and Ginger). — Dose, y2,- 
I drachm (2.0-4.0 Gm.). 

Tinctiira Rhei — Tincturae Rhei — Tincture of Rhubarb (10 per cent., with 
Cardamom). — Dose, j^-4 fluidrachms (2.0-15.0 Cc). 

Tinctura Rhei AromStica — Tincturae Rhei Aromaticae — Aromatic Tincture 
of Rhubarb (20 per cent., with Cassia, Cinnamon, Cloves, and Nutmeg). — Dose, 1-3 
fluidrachms (4.0-12.0 Cc). 

This preparation is used to make Syrupus Rhei Aromaticus. 

Tinctura Rhei Dtilcis— Tinctiirae Rhei Dtilcis— Sweet Tincture of Rhubarb 
(10 per cent., with Glycyrrhiza, Anise, and Cardamom). — Dose, J^-4 fluidrachms (2.0- 
15.0 Cc). 

Mistura Rhei et Sodae — Misturae Rhei et Sodae— Mixture of Rhubarb and 
Soda. — Formula: Sodium Bicarbonate, 35; Fluid Extract of Rhubarb, 15; Fluid 
Extract of Ipecac, 3 ; Glycerin, 350 ; Spirit of Peppermint, 35 ; Water, to 1000. — Dose^ 
%-'2. fluidounces (8.0-60.0 Cc). 

Syrupus Rhei — Syrupi Rhei — Syrup of Rhubarb. — Formula: Fluid Extract 



CATHARTICS. 679 

of Rhubarb, 100 ; Potassium Carbonate, 10; Spirit of Cinnamon, 4; Glycerin, 50; 
Water and Syrup, to 1000. — Dose, I-4 fluidrachms (4.0-15.0 Cc). 

Syrupus Rhei Aromaticus — Syrupi Rhei Aromatici — Aromatic Syrup of 
Rhubarb. — Formula: Aromatic Tincture of Rhubarb, 150; Syrup, 850. — Dose, ^-2 
fluidrachms (2.0-8.0 Cc). 

Physiological Action and Therapeutics. — Rhubarb in mod- 
erate doses is a stomachic, acting similarly to the aromatic bitters, 
increasing secretion, peristalsis, vascularity, and absorption, thereby 
aiding digestion and serving as a tonic. In larger doses it is a 
mild cathartic, producing in from four to eight hours a soft yellow- 
ish-brown evacuation, not watery, which is not infrequently accom- 
panied by griping. 

It undoubtedly slightly increases the secretion of bile, though 
it is by no means an active hepatic stimulant. 

After full doses of rhubarb have been taken the purgative action 
is succeeded by quiescence of the bowels, the constipation being 
the result of the action of the astringent constituents of the rhu- 
barb. Small doses, however, taken daily, serve a useful purpose 
in relieving habitual constipation, without in the least impairing 
digestion. 

The drug is excreted with the feces, urine, perspiration, and 
milk ; the urine is slightly increased in amount, and together 
with the perspiration and milk, is colored yellow. The milk 
acquires a bitter taste and purgative properties. 

Rhubarb is one of the best purgatives for children suffering 
from diarrhea caused by irritating ingesta in the bowels or to cold ; 
it is also of value in some cases of dysentery. Summer diarrhea 
of children is often cured by some preparation of rhubarb alone, 
the diarrhea ceasing after a free purge by the drug. 

As a simple laxative for children it is a valuable remedy, owing 
to its secondary tonic and astringent effects, and is recommended 
as a laxative to expel thread-worms. 

When hemorrhoids are connected with constipation, much relief 
may be obtained by the gentle action of rhubarb. 

Administration. — Rhubarb is seldom given alone, because of 
the griping it occasions. For children the syrups are excellent 
preparations, and the mixture of rhubarb and soda is an appropri- 
ate remedy when the secretions of the stomach and bowels are 
unduly acid. 

In habitual constipation of adults the simple rhubarb pill is an 
efficient preparation. 



68o A TEXT-BOOK OF MA TERIA MEDIC A. 

The choice of the preparation will depend largely upon the 
individual case. 

Euonymus— Euonymi— Euonymus. V. S. I*. 

(Wahoo.) 

Orig-in. — The bark of the root of Euonymus atropurpureus 
Jacquin, a shrub 6 to lo or 14 feet (1.8 to 3 or 4.2 M.) high, found 
growing in shady woods of the northern and middle section of the 
United States east of the Mississippi. 

Description and Properties. — In quilled or curved pieces -^ to 
\ inch (2 to 5 Mm.) thick ; outer surface ash-gray, with blackish 
patches, detached in thin and small scales ; inner surface whitish 
or sKghtly tawny, smooth ; fracture smooth, whitish, the inner 
layers of a laminated appearance ; nearly inodorous ; taste sweet- 
ish, somewhat bitter and acrid. 

The chief constituent of the drug is a resin, euonymin. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Official Preparation. 

Extractum EuSnymi — Extr^cti Eu6nymi — Extract of Euonymus. — Dose, 

1-5 grains (0.06-0.3 Gm.). 

Euonymin (unofficial). — Origin. — A resin from the root and stem-bark of 
Euonymus atropurpureus Jacquin. 

Description and Properties. — A brown or greenish-brown hygroscopic powder with 
a feebly bitter taste, soluble in water, almost insoluble in alcohol and ether. 

Dose. — yi-Z grains (0,01-0.19 Gm,), 

Physiological Action and Therapeutics. — Euonymus resem- 
bles rhubarb in its action, but is milder, small doses being stimu- 
lant to the stomach. The drug is an active hepatic stimulant, 
increasing the secretion of bile and facilitating its excretion into the 
intestine. It is excreted by the kidneys and broncho-pulmonary 
mucous membrane, being a mild diuretic and expectorant. Euony- 
mus is an excellent cathartic, particularly in cases of constipation 
attended with impaired functional activity of the liver. 

Euonymin is the preparation usually employed, although the 
official extract of euonymus is a reliable preparation. 

Tris— Tridis— Iris. U.S.I'. 

(Blue Flag.) 
Orig-in. — The rhizome and roots of Iris versicolor L,, found 
growing in wet and swampy meadows from Canada southward to 
Florida and westward to Minnesota and Arkansas. 



CATHARTICS. 68l 

Description and Properties. — Rhizome of horizontal growth, 
-consisting of joints 2 to 4 inches (5 to 10 Cm.) long, cylindrical in 
the lower half, flattish near the upper extremity, and terminated 
by a circular scar, annulated from the leaf-sheaths, grayish-brown ; 
roots long, simple, crowded near the broad end ; odor slight ; taste 
acrid and nauseous. The drug contains an acrid resin, iridin, fixed 
oil, starch, gum, tannin, sugar, and indications of an alkaloid. 

Dose. — 10-30 grains (0.6-2.0 Gm.). 

Official Preparations. 

Extractum Iridis — Extract! Iridis — Extract of Iris. — Dose, 1-3 grains (0.06- 
0.2 Gm.). 

Extractum Iridis Fliiidum — ExtrScti Iridis Fluidi — Fluid Extract of Iris. 
— Dose, 10-30 minims (0.6-2.0 Cc). 

Iridin (unofficial). — Dose, 1-3 grains (0,06-0.2 Gm.). 

Physiological Action and Therapeutics. — Iris is similar in its 
action to euonymus, although it is more apt to disturb the stomach 
and occasion nausea. It is actively purgative and possesses diu- 
retic properties. Like euonymus, it is a hepatic stimulant, and 
may be used for the same purposes as the former drug. It may 
be used in dropsy ^ and has been found to be an efficient cathartic 
in malarial 2Xidi catarrhal jaundice and bilions remittent fever. It 
exerts a specific influence in enlargement of the thyroid gland. 

The dried drug is inert, the fluid extract and iridin being the 
most reliable preparations to use. 

Juglans— Juglandis— Juglans. TJ. S, JP. 

(Butternut.) 

Origin. — The bark of the root of Jngla^is cinerea L., a tree 
30 to 40 feet (9-12 M.) high, growing in forest and bottom-lands 
in Canada, and the greater portion of the United States westward 
to Missouri and Arkansas. 

Description and Properties. — In flat or curved pieces, from -|- 
to \ inch (3 to 6 Mm.) thick ; the outer surface dark gray and 
nearly smooth or deprived of the soft cork, and deep brown ; the 
inner surface smooth and striate ; transverse fracture short, deli- 
cately checkered, whitish and brown ; odor feeble ; taste bitter and 
somewhat acrid. The drug contains a bitter, oily extractive, 
juglandic acid, two other acids, and various salts. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 



682 A TEXT-BOOK OF MA TERIA MEDICA. 

Official Preparation. 

Extractum Jugl^ndis — Extract! Jugl^ndis —Extract of Juglans. — Dose^ 5-30 
grains (0.3-2.0 Gm.). 

Physiological Action and Therapeutics. — The action and 
medical uses of this drug are analogous to those of euonymus. 

Leptandra— Leptandrae— Leptandra. JJ. S. J*. 

(Culver's Root.) 

Origin. — The rhizome and roots of Veronica virginica L., a 
plant indigenous in Canada, and in the United States as far west as 
the Mississippi Valley. 

Description and Properties. — Of horizontal growth, from 4 to 
6 inches (10 to 15 Cm.) long and about \ inch (6 Mm.) thick, some- 
what flattened, bent and branched, deep blackish-brown, with cup- 
shaped scars on the upper side, hard, of a woody fracture, with a 
thin, blackish bark, a hard, yellowish wood, and a large, purplish- 
brown, about six-rayed pith ; roots thin, wrinkled, very fragile ;, 
inodorous ; taste bitter and feebly acrid. 

Leptandra contains a crystalline glucosid, leptandrin, besides 
tannin, gum, and a small quantity of volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.). 

Official Preparations. 

Extractum Leptandrae — Extr^cti LeptSndrae — Extract of Leptandra. — Doscy 
1-5 grains (0.06-0.3 Gm.). 

ExtrSctum Leptandrae Fluidum — Extract! LeptSndrae Fluidi — Fluid Ex- 
tract of Leptandra. — Dose, 15-60 minims (1.0-4.0 Cc). 

The Pilulae Catharticae Vegetabiles contain ^ grain (o.oi Gm.) of Extract of 
Leptandra to each pill. 

Leptandrin (unofficial). — Dose, 1-3 grains (0.06-0.2 Gm.). 

Physiological Action and Therapeutics. — The action of lep- 
tandra is similar to the actions of euonymus, iris, and juglans, the 
green root, however, being more of an irritant to the gastro-intes- 
tinal tract, possessing marked emeto-cathartic properties. 

It is an active hepatic stimulant, and may be advantageously 
employed for the same purposes as euonymus, iris, etc. 

Senna— Sennae— Senna. TJ, S, IP. 

Origin. — The leaflets of Cassia actitifolia Delile (Alexandria 
senna) and of Cassia angtistifolia Vahl (India senna), small shrubs 



CATHARTICS. d^T^ 

found in Upper Egypt and southward to Nubia, Sennaar, and Kor- 
dofan, and farther westward in tropical Africa {Cassia acutifolia), and 
in Southwestern Arabia, along the Somali coast of Africa, and east- 
ward in Northern India {Cassia aiigustifolid). 

Description and Properties. — Alexandria senna consists of 
leaflets about i inch (25 Mm.) long and | inch (10 Mm.) broad, 
lanceolate or lance-oval, subcoriaceous, brittle, rather pointed, un- 
equally oblique at the base, entire, grayish-green, somewhat pubes- 
cent ; of a peculiar odor and a nauseous, bitter taste. 

India senna consists of leaflets i to 2 inches (2.5-5 Cm.) long 
and f to f inch (10-15 Mm.) broad, lanceolate, acute, unequally 
oblique at the base, entire, thin, yellowish-green or dull green, 
nearly smooth ; odor peculiar, somewhat tea-like ; taste mucilagi- 
nous, bitter, and nauseous. 

Senna contains a sulphuretted glucosid, cathartic acid, to which 
the purgative properties of the drug are due. Senna also contains 
chrysophan, besides sennacrol and sennapicrin (two bitter princi- 
ples), catharto-mannite, mucilage, etc. 

Dose. — 10 grains-3 drachms (0.6-12.0 Gm.). 

Official Preparations. 

ConfSctio SSnnae — Confectionis SSnnae — Confection of Senna. — 10 per cent., 
with Cassia Plstula, Tamarind, Prune, Fig, Sugar, and Oil of Coriander. Dose, 1-3 
drachms (4.0-12.0 Gm,). 

ExtrSctum SSnnae Fluidum— Extracti SSnna Fluidi— Fluid Extract of 
Senna, — Dose, 10 minims-3 fluidrachms (0.6-11,09 Cc). 

Infusum SSnnae Compositum — Infusi SSnnse Comp6siti — Compound Infu- 
sion of Senna. — 6 per cent., with Manna and Magnesium Sulphate, each, 12 per cent., 
and Fennel 2 per cent. Dose, 1-2^ fluidounces (30,0-75,0 Cc). 

Ptllvis Glycynhlzae CompSsitus — Ptilveris Glycyrrhlzae Compositi — Com- 
pound Powder of Glycyrrhiza. — Formula: Senna, 180; Glycyrrhiza, 236; Oil of 
Fennel, 4; Washed Sulphur, 80; Sugar, 500. Dose, ^-2 drachms (2,0-8,0 Gm.). 

Syrapus SSnnae — Syrupi SSnnae — Syrup of Senna (25 per cent,), — Dose, ]^-\ 
fluidounce (8,0-3,0 Cc). 

Cathartic Acid, Cathartinic Acid (unofficial), — Origin. — An active principle 
obtained from the leaves of various species of Cassia. 

Description and Properties. — It occurs as brown, hygroscopic scales, freely soluble in 
water and in alcohol. 

Dose, — 2-6 grains (0,12-0.38 Gm,). 

Physiological Action and Therapeutics.^ — Senna is an active 
purgative, acting upon nearly the entire intestinal tract, increasing 
both peristalsis and intestinal secretion, although having but little 
effect upon the biliary secretion. It is apt to occasion much flatu- 
lence and griping unless it is associated with aromatics. Full doses 



684 A TEXT-BOOK OF MATERIA MEDIC A. 

open the bowels in from four to eight hours, producing one or 
more copious liquid, yellow stools, but never occasioning hyper- 
catharsis, and the purgation is not followed by constipation. 

An infusion of senna, if injected into the veins, excites both 
vomiting and purging. 

Some persons are so susceptible to the influence of senna as to 
be purged even by its odor. 

The drug, or some constituent of it, is eliminated by the urine, 
to which it imparts a red color, and by the milk, rendering it pur- 
gative. 

The various preparations of senna are very efficient purgatives 
in cases of simple constipation or in cases oi fecal accumulation in 
the colon. 

Infusion of senna is an admirable purgative with which to suc- 
ceed the administration of blue pill. In cases of biliousness there is 
probably no better treatment than calomel or blue pill at night and 
infusion of senna in the morning. 

Habitual constipation and the constipation of pregnancy are safely 
and agreeably treated by compound liquorice powder. 

Administration. — Senna is seldom given alone, but is generally 
associated with some corrective to prevent griping. 

The infusion, compound liquorice powder, syrup, and confection 
of senna are employed. 

The compound liquorice powder and the confection being the 
mildest and pleasantest, the latter preparation, when coated with 
chocolate, is readily taken by children, and in this form is the well- 
known laxative " Tamar Indien!' 

HYDRAGOGUE PURGATIVES. 

These drugs are more active than the preceding class, pro- 
ducing an abundant secretion from the intestinal mucous mem- 
brane, removing a large quantity of water from the blood-vessels, 
and producing several copious, watery stools. 

Oleum Tiglii— Olei Tiglii— Croton Oil. V. S. P. 

Origin. — A fixed oil expressed from the seed of Croton Tiglium 
L., indigenous in Hindostan and some of the East Indian and 
Philippine islands. 

Description and Properties. — A pale-yellow or brownish-yel- 
low, somewhat viscid, and slightly fluorescent liquid, having a slight, 
fatty odor, and a mild, oily, afterward acrid and burning, taste 



! 



CATHARTICS. 68 S 

i^great caution is necessary in tasting). Croton oil should be kept 
in small, well-stoppered bottles, and should be handled with caution, 
for when applied to the skin it produces rubefaction or a pustular 
eruption. 

When fresh, croton oil is soluble in about 60 parts of alcohol, 
the solubility increasing by age. 

The drug contains several volatile acids, of which tiglinic acid 
is the characteristic one ; besides this, it contains lauric, myristic, 
palmitic, stearic, formic, acetic, isobutyric, and isovalerianic acids. 

Dose. — 1-2 minims (0.01-0.12 Cc.) on a lump of sugar or mixed 
with some bland oil. 

Physiolog-ical Action. — Externally and Locally. — Croton oil is 
a powerful irritant when applied to the skin, exciting inflammation 
and quickly producing vesication, which rapidly merges into pus- 
tules closely resembling those of variola, and perhaps lasting 
several days. In many cases permanent cicatrices mark the sites 
of these pustules. 

If the drug be rubbed over the abdomen, it may produce pur- 
gation. The irritating action is wholly due to the free croton- 
oleic acid which the oil contains. 

htternally. — When a drop or two of croton oil is taken into the 
stomach it occasions a sense of heat in the epigastrium, which is 
soon succeeded by griping and abdominal pain, and in from half 
an hour to two hours after the ingestion of the drug there are pro- 
duced profuse watery stools, with considerable burning and irrita- 
tion about the anus. 

The drug greatly increases the vascularity of, and the secretion 
from, the gastro-intestinal tract, without specially influencing the 
biliary secretion. 

Large doses produce violent gastro-enteritis, hypercatharsis, 
with great prostration and collapse resembling that of cholera. 

In case of poisoning the stomach should be immediately evacu- 
ated, and demulcent drinks freely given. Opium and stimulants 
may be necessary. 

Therapeutics. — Externally and Locally. — The external use of 
croton oil is comparatively limited. 

It is occasionally painted over the seat of pain in intercostal 
neuralgia, while a liniment of croton oil applied to the chest is said 
to be beneficial in phthisis and chronic bronchitis. The same prep- 
aration is recommended as a local application in congestive dysmen- 
orrhea and chronic congestion of the uterus. 



686 A TEXT- BOOK OF MATERIA MEDIC A, 

Croton oil has been put to many other uses, but the results ob- 
tained are so unsatisfactory that it is needless to enumerate them. 

Internally. — The drug is used as a purgative, as a rule only in 
cases of emergency, and then a single dose is usually sufficient. 
It is employed in such cases as intestinal obstruction from accumu- 
lated feces produced by torpor of the bowels, diseases of the nervous 
system, lead-poisoning, etc. In lead colic it is probably superior to 
all other purgatives. 

Croton oil is sometimes employed for its revulsive action in 
apoplexy. 

As a purgative it is frequently given to lunatics, because, on 
account of the smallness of the dose, it may be easily placed on 
the back of the tongue, where it is quickly swallowed reflexly. 

Contraindications. — The drug should never be given to preg- 
nant women, to children, nor to patients suffering from hemor- 
rhoids, peritonitis, gastritis, or enteritis. 

Administration. — Croton oil may be given in emulsion, or 
mixed with some bland oil, or dropped on a piece of loaf sugar, or 
in pill form. 

The best excipient for pills of croton oil is breadcrumb. 

Elaterlnum— Elaterlni— Elaterin. 77. H. JP. 

Orig-in. — A neutral principle obtained from Elaterium, a sub- 
stance deposited by the juice of the fruit of Ecballium elaterium 
L., commonly known as " squirting cucumber," a vine growing in 
the Mediterranean regions of Europe, Africa, and Asia. 

Description and Properties. — Minute, white, hexagonal scales 
or prismatic crystals, without odor, and having a sHghtly acrid, 
bitter taste; permanent in the air; soluble in 4250 parts of water 
and 337 parts of alcohol. 

Dose. — ^o~A" grain (0.002-0.005 Gm.). 

Official Preparation. 

Trituratio Elaterlni — Triturationis Elaterlni — Trituration of Elaterin. — 

Dose, about f grain (0.05 Gm.). 

Physiological Action and Therapeutics. — Elaterin is the most 
powerful hydragogue purgative known. 

The drug greatly increases the salivary, gastric, and intestinal 
secretions, as well as those from the liver and pancreas. 

It is a violent purgative, whether given internally or injected 



CATHARTICS. 687 

subcutaneously, producing abundant watery evacuations attended 
with much griping pain and great prostration. 

Elaterin is indicated where profuse serous discharges are de- 
sired, as in cases of congestion of tlie brain and lungs, ascites, and 
chronic nephritis. 

Contraindications. — The drug is not permissible in inflamma- 
tory conditions of the gastro-intestinal tract, nor in pregnancy, 
and it should be administered with much care, if at all, in heart 
disease. 

Administration. — The drug may be given in pill form, in alco- 
holic solution, or in the form of the trituration. Elaterin varies 
greatly in strength, which suggests caution in its use. 



Cambogia—Cambogiae— Gamboge. TJ, S» J*. 

Origin. — A gum-resin obtained from Garcinia Hanhirii Hooker 
iilius, a medium-sized tree, indigenous in Siam, Cambodia, and 
Cochin China, 

Description and Properties. — In cylindrical pieces, sometimes 
hollow in the center, i to 2 inches (2 to 5 Cm.) in diameter, longi- 
tudinally striate on the surface ; fracture flattish-conchoidal, of a 
waxy luster, orange-red ; in powder bright yellow ; inodorous ; 
taste very acrid ; the powder sternutatory. Gamboge is partly 
soluble in alcohol and in ether. 

Dose. — 1-5 grains (0.06-0.32 Gm.). 

Official Preparation. 

Pilulae Catharticae Compositae — Pilulas (ace.) Catharticas CompSsitas — 
Compound Cathartic Pills. — Dose, 1--3 pills. 

Physiological Action and Therapeutics. — Gamboge is a vio- 
lent hydragogue purgative, exciting active peristalsis and greatly 
augmenting the secretion from the intestinal glands, although not 
increasing the secretion of bile. Small and repeated doses are 
slightly diuretic, coloring the urine yellow. 

Gamboge is seldom given alone, being usually associated with 
other purgatives. It is used in combination when a hydragogue 
action by the kidneys as well as the bowels is desired. It is 
thought to be of use in hepatic congestio7i arising from malarial 
causes. The drug is an efficient anthelmintic, and is occasionally 
prescribed with vermicide medicines. 



688 A TEXT-BOOK OF MATERIA MEDICA. 

SALINES. 

Magnesii Citras Effervescens— Magnesii Citratis 
Effervescentis— Effervescent Magnesium Ci- 
trate. V. S. I". 

Formula : Magnesium Carbonate, lO ; Citric Acid, 46 ; Sodium 
Bicarbonate, 34 ; Sugar, 8 ; Alcohol and Distilled Water, a suf- 
ficient quantity. 

Description and Properties. — A white, coarsely granular salt, 
without odor, and having a mildly acidulous, refreshing taste. 
Deliquescent on exposure to the air. Soluble, with copious effer- 
vescence, in 2 parts of water ; almost insoluble in alcohol. The 
product should be kept in well-closed vessels. 

Dose. — ^i ounce (8.0-32.0 Gm.). 

Liquor Magnesii Citratis— Liquoris Magnesii Citratis 
—Solution of Magnesium Citrate. TI. S. JP. 

Formula: Dissolve Magnesium Carbonate, 15, in a solution of 
Citric Acid, 30 ; add Syrup of Citric Acid, 60 ; then Crystals of 
Potassium Bicarbonate, 25. Cork the bottle and wire immediately. 
The product effervesces when uncorked. 

Dose. — 2-8 fluidounces (60.0-237.0 Cc). 

Magnesii Sulphas— Magnesii Sulphatis— Magne- 
sium Sulphate. U. S, JP, 

(Epsom Salt.) 

Origin. — Obtained by the action of Sulphuric Acid upon native 
Magnesium Carbonate, treated with Water, filtered, and the filtrate 
evaporated to crystallization. 

Description and Properties. — Small, colorless, rhombic prisms 
or acicular crystals, without odor, and having a cooling, saline, 
and bitter taste; slowly efflorescent in dry air. Soluble in 1.5 
parts of water ; insoluble in alcohol. 

Dose. — ^i ounce (8.0-32.0 Gm.). 

Antagonists and Incompatibles. — Magnesium sulphate is in- 
compatible with alkaline carbonates, phosphoric acid, phosphates, 
lead acetate, silver nitrate, and lime water. 

Synergists. — Saline purgatives. 

Potassii Sulphas— Potassii Sulphatis— Potassium 
Sulphate. U. S. J>. 

Origin. — Prepared by adding Potassium Carbonate to Acid 
Potassium Sulphate. 



CATHARTICS. 689 

Description and Properties. — Hard, colorless, transparent, six- 
sided, rhombic prisms terminated by pyramids, or in white powder ; 
odorless, and having a somewhat bitter, saline taste. Permanent 
in the air. Soluble in about 9.5 parts of water, insoluble in 
alcohol. 

Dose. — J-4 drachms (2.0-16.0 Gm.). 

Potassii et Sodii Tartras— Potassil et Sodii Tartratis 
—Potassium and Sodium Tartrate. TJ. S. B, 

(RocHELLE Salt.) 

Origin. — Prepared by adding Acid Potassium Tartrate to a hot 
solution of Sodium Carbonate. 

Description and Properties. — Colorless, transparent rhombic 
prisms, or a white powder, odorless, and having a cooling, saline 
taste. The crystals sHghtly effloresce in dry air. Soluble in 1.4 
parts of water, almost insoluble in alcohol. 

Dose. — 30 grains-i ounce (2.0-32.0 Gm.). 

Official Preparatioji. 

Piilvis EffervSscens Compositus — Ptilveris EffervescSntis Comp6siti — 
Compound Effervescing Powder (Seidlitz Powder). — Each powder has of Ro- 
chelle Salt, 120 grains (8.0 Gm.) ; of Sodium Bicarbonate, 40 grains (3.0 Gm.), mixed 
in a bkie paper; and of Tartaric Acid, 35 grains (2.26 Gm.), in a white paper. 

Dose. — One or two of each dissolved separately in separate quantities of water, the 
solutions poured together and drunk while effervescing. 

Sodii Phosphas— Sodii Phosp hat is— Sodium Phos- 
phate. V.H.T. 

(Sodium Orthophosphate.) 

Origin. — Prepared by digesting Bone Ash with Sulphuric Acid. 
The solution is filtered, and to it is added Sodium Carbonate, and 
the filtrate evaporated to crystallization. 

Description and Properties. — Large, colorless, monoclinic 
prisms, odorless, and having a cooHng, saHne taste. The crys- 
tals effloresce in the air, and gradually lose 5 molecules of water 
of crystallization. Soluble in 5.8 parts of water; insoluble in 
alcohol. Sodium phosphate should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 5 grains-i ounce (0.32-32.0 Gm.). 

44 



690 A TEXT-BOOK OF MATERIA MEDICA. 

S5dii Sulphas— S5dii Sulphatis— Sodium Sulphate. 

U. S.JP. 

(Glauber's Salt.) 

Origin. — The residue left in the manufacture of Hydrochloric 
Acid from Salt is neutralized with Sodium Carbonate. 

Description and Properties. — Large, colorless, transparent, 
monoclinic prisms or granular crystals ; odorless, and having a 
bitter, saline taste. The salt effloresces rapidly in the air, and 
finally loses all its water of crystalHzation. Soluble in 2.8 parts 
of water and in glycerin ; insoluble in alcohol. 

Dose. — 1-8 drachms (4.0-32.0 Gm.). 



Physiological Action and Therapeutics of the Salines. — These 
preparations greatly augment the amount of fluid in the intestinal 
canal. This increase of fluid is not a secretion, but a result of the 
high osmotic equivalent of the salts which tends to draw the body- 
fluids into the intestines, while hindering to a certain extent absorp- 
tion of fluid from the intestines. The purgative influence is really 
due to the mechanical action of the fluid in the intestines. 

Save the sulphate and phosphate of sodium, which are mild he- 
patic stimulants, the salines have no effect upon the biliary secretions. 

The sodium salts are more efficient than the potassium salts as 
purgatives, owing to their higher osmotic equivalents. 

Purgation by the salines is painless, and occurs usually in from 
two to three hours after administration, there being ordinarily two 
or three watery evacuations. 

In cases of habitual constipation, particularly that associated 
with thQgotity diathesis, there are no better purgatives than the salts 
OF SODIUM or mineral waters containing them, such as Carlsbad, 
Marienbad, Hunyadi Janos, etc. 

For children there is no better purgative than sodium phos- 
phate, especially where the stools show a deficiency of bile. In 
duodenal catarrh excellent results are obtained by this drug ; also 
in chronic rheumatism, and to retard the formation of biliary calculi. 

Concentrated saline purgatives are efficient remedies for the 
removal of dropsical and pleuritic effusions. 

Magnesium sulphate, combined with dilute sulphuric acid, is 
the most efficient treatment in cases of chronic lead-poisoniftg. 

RocHELLE SALT and Seidlitz powder are pleasant and useful 
purgatives in cases of biliousness, migraine, etc. Solution of mag- 



CATHARTICS.. 691 

NESiUM CITRATE is uscd for the same purpose, but, while very- 
palatable and acceptable to the stomach, is not always reliable, 
besides being apt to occasion slight griping. 

Administration. — The salines should be taken dissolved in 
as concentrated a solution as possible, and ordinarily should be 
administered in the morning, when the stomach is empty. 

DRASTIC PURGATIVES. 

These drugs are even harsher in their action than hydragogue 
purgatives, exciting violent peristalsis, and in large doses producing 
gastro-enteritis . and all the symptoms occasioned by an irritant 
poison. The evacuations produced by these drugs are numerous, 
copious, and watery, attended with much griping pain, tenesmus, 
and borborygmi. 

Colocynthis— Colocynthidis-Colocynth. TJ. S. P. 

Origin. — The fruit of Citrullits Colocynthis Schroder, deprived 
of its rind. The colocynth plant is indigenous in Japan and is 
cultivated and naturaHzed in Spain. 

Description and Properties. — From 2 to 4 inches (5-10 Gm.) 
in diameter; globular; white or yellowish-white, hght, spongy; 
readily breaking into three wedge-shaped pieces, each containing, 
near the rounded surface, many flat, ovate, brown seeds ; inodor- 
ous ; taste intensely bitter. 

The active constituent of colocynth is colocynthin, a glucosid, 
of which there is present about 2 per cent. Colocynth also con- 
tains resin, gum, and an amyloid principle. 

Dose. — 5-10 grains (0.3-0.6 Gm.). 

Official Preparations. 

ExtrSctum Coloc5rnthidis— ExtrScti Colocynthidis— Extract of Colocynth. 

Dose, 1—2 grains (0.03-0.13 Gm.). 

Extractum Colocynthidis Comp6situm— Extr^cti Colocynthidis Comp6siti 
— Compound Extract of Colocynth. — Extract of Colocynth 16 per cent., with Aloes 
Scammony, Cardamom, and Soap. 

Dose. — 5-25 grains (0.3-1.6 Gm.). 

Compound Extract of Colocynth enters into the following pills : 

Pilulae Catharticse CompSsitae (8 per cent.). 

Pilulae Catharticae Vegetabiles (6 per cent.). 

Physiolog-ical Action and Therapeutics. — The action of colo- 
cynth is very similar to that of elaterin. In small doses, however, 



692 A TEXT-BOOK OF MATERIA MEDIC A. 

it rather acts as a stomachic, improving the appetite and augment- 
ing the secretions of the whole gastro-intestinal tract. Colocynth 
is quite a decided hepatic stimulant and cholagogue. 

Pills containing colocynth are useful to produce abundant 
watery evacuations, as is necessary sometimes in the treatment of 
hepatic and reiial diseases where there is constipation and ascites. 

The drug should be employed only when there is some marked 
indication for its use, as colocynth, hke the other drastics, is too 
irritant for habitual use. 

Gastro-intestinal inflammation, pregnancy, etc., would contra- 
indicate its use. 

Jalapa—Jalapae— Jalap. V. S. I^. 

Orig-in. — The tuberous root of Iponicea Jalapa Nuttall, a twin- 
ing herbaceous perennial growing in damp and shady woods on 
the eastern slope of the Mexican Andes. It has been introduced 
into India and Jamaica. 

Description and Properties. — Napiform, pyriform, or oblong, 
varying in size, the large roots incised, more or less wrinkled, dark 
brown, with lighter-colored spots and short, transverse ridges ; 
hard, compact, internally pale grayish-brown, with numerous con- 
centric circles composed of small resin-cells ; fracture resinous, not 
fibrous ; odor slight, but peculiar, smoky, and sweetish ; taste 
sweetish and acrid. 

Jalap contains two resins, one hard, the other soft, the former, 
termed jalapin or convolvtdi?t, being the active principle of the 
drug. According to the U. S. Pharmacopoeia, there must be not 
less than 12 per cent, of resin, of which not less than 10 per cent, 
must be soluble in ether. 

Dose. — 5-30 grains (0.32-2.0 Gm.). 

Official Preparations. 

Extractum Jalapae — Extract! Jalapse — Extract of Jalap. — Dose, 2-5 grains 
(0.13-0.3 Gm.). 

Ptilvis Jalapae CompSsitus — Ptllveris Jalapae Comp6siti — Compound Jalap 
Powder (35 per cent., with Potassium Bitartrate). — Dose, 15-60 grains (1.0-4.0 Gm.). 

Reslna Jalapae — Resinae Jalapae — Resin of Jalap. — Description and Proper- 
ties. — Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy 
fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, having 
a slight, peculiar odor, and a somewhat acrid taste. Permanent in the air. Soluble in 
alcohol in all proportions. 

Dose. — 2-5 grains (0.13-0.3 Gm.). 

Extract of Jalap is one of the ingredients of Piiulae Catharticae Compositae 
and Piiulae Catharticae Vegetabiles. 



CATHARTICS. 693 

Physiolog-ical Action and Therapeutics. — The purgative 

action of jalap is developed in the duodenum, where it comes in 
contact with the bile. The secretion from the intestinal glands is 
greatly augmented, as well as the vascularity and peristalsis of the 
intestines. The biliary flow is but little affected. 

Purgation is produced by jalap in three or four hours, the 
evacuations being profuse and watery and attended with griping 
pain. 

Jalap — or, preferably, the compound jalap powder — is a reliable 
hydragogue cathartic for the removal of di^opsical effusions, being 
especially appropriate for nephritic patients. 

Small doses of jalap are serviceable in constipation due to de- 
ficient intestinal secretion. 

The drug is frequently associated with anthelmintic medicines 
as a vermifuge. 

Scammonium— Scammonii— Scammony. TJ, S. P. 

Origin. — A resinous exudation from the living root of Co7ivol- 
vuhis Scammonia L., a herbaceous, twining perennial, growing 
in Syria, Asia Minor, and Greece. 

Description and Properties. — Occurring in irregular angular 
pieces or circular cakes, greenish-gray or blackish, internally por- 
ous, and breaking with an angular fracture, of a resinous luster ; 
odor peculiar, somewhat cheese-like ; taste slightly acrid ; powder 
gray or greenish-gray. 

It contains a VQsm,jalapin, which is the active principle, besides 
gum, starch, etc. 

Dose. — 1-15 grains (0.06-1.0 Gm.). 

Official Preparation. 

Resina Scammonii — Reslnae Scammonii — Resin of Scammony. — Descrip- 
tion and Properties. — Yellowish-brown or brownish-yellow masses or fragments, break- 
ing with a glossy, resinous fracture, translucent at the edges, or a yellowish-white or 
grayish-white powder, having a faint, peculiar odor, and a slight, peculiar taste. Soluble 
in alcohol in all proportions. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Physiological Action and Therapeutics. — The action of scam- 
mony is identical with that of jalap, save that it stimulates the 
muscular coat of the intestines more, producing more irritation 
and griping than jalap, though not increasing secretion so much 
as the latter drug. 



694 ^ TEXT-BOOK OF MATERIA MEDIC A. 

The therapeutics are the same as for jalap. 

The drug may be given in powder, emulsion, or in milk, but is 
inactive in pilular form. 

Podophyllum— Podophylli— Podophyllum. V. S. J*. 

(May Apple.) 

Origin. — The rhizome and roots of Podophyllum peltatum L., an 
herbaceous perennial growing in rich woodlands in Canada and the 
United States. 

Description and Properties. — Of horizontal growth, consisting 
of joints about 2 inches (5 Cm.) long, flattish cylindrical, about 
\ inch (6 Mm.) thick, but somewhat enlarged at the end, which 
has a circular scar on the upper side, a tuft of about ten nearly 
simple, fragile roots on the lower side, and is sometimes branched 
laterally ; smooth or somewhat wrinkled, orange-brown, internally 
white and mealy, with a circle of small wood-bundles ; pith large ; 
nearly inodorous ; taste sweetish, somewhat bitter and acrid. 

Podophyllum contains a resin, podophyllin, composed princi- 
pally of podophyllotoxin, which is probably a mixture of picropodo- 
phyllin, the purgative principle, and podophyllinic acid, an inactive 
resin acid. Among other constituents of the drug are several 
minor resins and a coloring principle. 

Dose. — 5-20 grains (0.32-1.29 Gm.). 

Official Preparations. 

Extractum Podophylli — Extr^cti Podophylli — Extract of Podophyllum. — 

Dose, 1-3 grains (0.06-0.2 Gm.) 

Extractum Podophylli Fluidum— ExtrScti Podoph5rlli Fluidi— Fluid Ex- 
tract of Podophyllum. — Dose, 5-20 minims (0.32-I.29 Cc). 

Resina Podophylli — Resinae Podophylli — Resin of Podophyllum. — Descrip- 
tion and Properties. — An amorphous powder, varying in color from grayish-white to 
pale greenish-yellow or yellowish-green, turning darker when exposed to heat; having 
a slight peculiar odor and a peculiar, faintly J^itter taste; permanent in the air; soluble 
in alcohol in all proportions. 

Dose. — |-i grain (0.008-0.06 Gm,). 

PodophyllotSxin (unofficial). — Dose, y^q-jo grain (0.0006-0.006 Gm.). 

Physiological Action and Therapeutics. — The powdered root 
is an irritant to the skin, and when inhaled occasions a decided 
irritation of the eyes and respiratory passages. It is absorbed 
when applied to ulcers and raw surfaces, producing its character- 
istic purgative effects. The drug is a gastro-intestinal irritant, being 



ANTHELMINTICS. 695 

apt to excite nausea, in full doses producing salivation and greatly 
augmenting the intestinal secretions, and especially the bile. Under 
full doses of podophyllum there is marked peristalsis, attended 
with severe griping pains, and in the course of ten or twelve hours 
there is produced a complete evacuation of the bowels, the feces 
being liquid and deeply stained with bile. 

The drug being one oi the most active hepatic stimulants and 
cholagogues in the Pharmacopoeia, it is a peculiarly appropriate 
remedy in that condition known as torpor of the liver. The con- 
stipation attending hepatic cirrhosis and cancer^ as well as that from 
any hepatic disorder, is well treated by podophyllum. 

The slowness and completeness of its action, together with its 
property of stimulating the functional activity of the liver, renders 
the drug extremely serviceable in the treatment of habitual consti- 
patio7t from any cause. 

It should, however, be associated with antispasmodics, such as 
hyoscyamus or belladonna, to overcome its griping. When asso- 
ciated with other purgatives care should be exercised to select 
those only which, like itself, are tardy in their action. 

Owing to the susceptibility of certain persons to the drug, 
the dosage should be small at first and gradually increased as 
necessary. 



GROUP XV.— ANTHELMINTICS. 

Anthelmintics are remedies which kill or expel intestinal 
worms. Those drugs which kill the parasites are called vermi- 
cides, and these which simply promote their expulsion are called 
vermifuges} 

The vermicides are — 

Aspidium, Kamala, 

Chenopodium, Oleum Terebinthinae,* 

Cusso, Pepo, 

Granatum, Santonica. 

The vermifuges are — 

Calomel,* Spigelia. 

Hydragogue Purgatives,* 
Anthelmintics are here divided according to the kind of intesti- 
nal parasite against which they are employed. 

The Oxyuris vermicularis is the small worm, often called seat- 

1 Drugs marked with an asterisk (*) are considered elsewhere. 



696 A TEXT-BOOK OF MATERIA MEDIC A. 

worm or thread-worm, that infests the large intestine and rectum. 
The Ascaris lumbricoides is the common round-worm, found chiefly 
in the small intestine. 

The Tcenice are the tape-worms. 

Remedies employed against the Oxyuris vermicularis : 
A weak solution of Carbolic Acid,* Lime Water,* 
Infusion of Quassia,* Calomel,* 

Decoction of Aloes,* Oleum Terebinthinse.* 

Remedies employed against the Ascaris lumbi^icoides : 
Chenopodium, Calomel,* 

Santonica, Hydragogue Purgatives,* 

Spigelia, Oleum Terebinthinae.* 

Remedies e^nployed against the Tcenia Solium and other varieties 
of Tcenia: 
Aspidium, Kamala, 

Cusso, Pepo, 

Granatum, Oleum Terebinthinse.* 

Chenopodium— Chenopodii— Chenopodium. 17. >S^. J*. 

(American Wormseed.) 

Origin. — The fruit of Chenopodium ambrosioides L., and the 
variety anthelminticum Gray, plants indigenous in the West Indies, 
and Central and South America, and naturahzed in the United 
States. 

Description and Properties. — Nearly -^ inch (2 Mm.) in diam- 
eter, depressed globular, dull greenish or brownish, the integu- 
ments friable, and containing a lenticular, obtusely-edged, glossy, 
black seed. It has a peculiar, somewhat terebinthinate odor, and 
a bitterish, pungent taste. It contains a volatile oil, to which its 
medical properties are due. 

Dose. — 15-30 grains (1.0-2.0 Gm.). 

Oleum Chenopodii— Oiei Chenopodii— Oleum Che- 
nopodii. TI.S.F. 

(Oil of American Wormseed.) 

Origin. — A volatile oil distilled from Chenopodium. 

Description and Properties. — A thin, colorless or yellowish 
liquid, having a peculiar penetrating, somewhat camphoraceous 
odor, and a pungent and bitterish taste. 

Dose. — 2-10 minims (0.12-0.6 Cc), 



ANTHELMINTICS. 697 

Physiological Action and Therapeutics. — Both the powdered 
SEED and the oil are efficient anthelmintics, particularly useful to 
expel round-worms {Ascaridcs htinbricoides) from children. The 
drug should invariably be followed by a brisk cathartic. The 
powder may be given suspended in molasses, or the oil may be 
given dropped upon loaf-sugar, or in the form of an emulsion, or 
enclosed in capsules. 

Santdnica— Santonicae— Santonica. JJ, S. P. 

(Levant Wormseed.) 

Origin. — The unexpanded flower-heads of Artemisia pauciflora 
Weber, a plant growing in Asia and exclusively collected in North- 
ern Turkestan. 

Description and Properties. — From -^-^ to \ inch (2 to 3 Mm.) 
long, oblong-ovoid, obtuse, smooth, somewhat glossy, grayish- 
green, after exposure to light brownish-green, consisting of an in- 
volucre of about twelve to eighteen closely imbricated, glandular 
scales with a broad midrib, enclosing four or five rudimentary 
florets ; odor strong, peculiar, somewhat camphoraceous ; taste 
aromatic and bitter. The drug contains about 2 per cent, of a 
neutral principle, santonin, to which its anthelmintic properties are 
due. It also contains about i per cent, of an unimportant volatile 
oil. 

Dose. — 10-60 grains (0.6-4.0 Gm.). 

Santonlnum—Santonlni— Santonin. 77. H, P, 

Origin. — A neutral principle obtained from Santonica. 

Description and Properties. — Colorless, shining, flattened, pris- 
matic crystals, odorless, and nearly tasteless when first put into the 
mouth, but afterward developing a bitter taste ; not altered by ex- 
posure to air, but turning yellow on exposure to light. Nearly 
insoluble in cold water ; soluble in 40 parts of alcohol. Santonin 
should be kept in dark, amber-colored vials, and should not be 
exposed to light. 

Dose. — l-i grain (0.016-0.06 Gm.) for a child; 1-5 grains 
(0.06-0.32 Gm.) for an adult. 

Official Preparation. 

Trochisci Santonini— Trochiscos (ace.) Santonini — Troches of Santonin. — 

Each troche contains ^ grain (0.03 Gm.). — Dose, 2 (child) to 10 troches (adult). 



698 A TEXT-BOOK OF MATERIA MEDICA. 

Physiolog-ical Action and Therapeutics. — In full or large 
doses santonin may excite nausea or vomiting, with abdominal 
pain, diarrhea, eructations, borborygmi, and great thirst. It readily 
enters the blood, where it exists as sodium santoninate. Larg-e 
doses may cause giddiness, headache, hallucinations of smell and 
taste, tremors, and a species of depression, the combination of 
symptoms forming what is called santonin intoxication. 

The drug is chiefly eliminated through the kidneys, small 
amounts of santonin even imparting to the urine a distinct yellow 
color if the urine is acid, and a decided purplish or even red color 
if the urine is alkaline. Under certain circumstances when the 
urine is decidedly alkaline, as in cases of cystitis, the administra- 
tion of santonin may produce so marked a discoloration of the 
urine as to suggest hematuria. 

Probably the most remarkable phenomenon attending the inges- 
tion of medicinal doses of santonin is that of xanthopsia or yellow 
vision, which may continue for several hours. According to Rose,, 
" there occasionally appears before the peculiar yellow sight, after 
large doses of santonin, a violet color of the field of vision : the 
intensity of this color is in proportion to the darkness of the objects 
looked at. All light objects, such as windows, paper, etc., appear 
actually yellow. Red and blue appear often in their complementary 
colors, orange and green, so that carmine-red appears pale, madder- 
red a bronze color, and the sky and blue objects green. This> 
however, is not always the case, and it has been noticed after the 
employment of santonin that red appears violet or light, and dark 
objects appear orange to one person, and to another green." 
(Quoted from Lewin.) This peculiar effect of santonin is due, 
according to Rose, to a nervous change in the retina or in the brain. 

Affections of the skin — e. g. urticaria — have occasionally fol- 
lowed the administration of santonin. Decidedly poisonous effects 
have sometimes been produced by comparatively small amounts of 
the drug. The symptoms of a fatal case from over-dose of santonin 
were convulsions accompanied by unconsciousness, twitching of the 
eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, 
and, after some hours, sudden death. 

In case of poisoning by santonin the remedial measures are in- 
ternal and external stimulants, eliminants, and artificial respiration. 
Santonin is certainly a most efficient remedy against the ascaris, 
and to a less extent it is of use against the oxyitris. It has no 
effect on the tcenia. 



ANTHELMINTICS. 699 

The drug should be given on an empty stomach, preferably at night, 
either alone or associated with calomel, and followed in two or three 
hours by castor oil or other brisk cathartic. It may be administered 
in the form of a powder mixed with sugar or jelly, or in pills or 
capsules. Troches of santonin a^e much used and are very efficient. 

Spigrelia— Spigreliae— Splgelia. TJ. S. I". 

(PiNKROOT.) 

Origin. — The rhizome and roots of Spigelia inarilandica L., 
a plant growing in rich shady woods, chiefly in the southern part 
of the United States, but found as far northward as Pennsylvania 
and Wisconsin. 

Description and Properties. — Of horizontal growth, about 2 
inches (5 Cm.) or more long, about \ inch (3 Mm.) thick, dark 
purpHsh-brown, bent, somewhat branched on the upper side, with 
cup-shaped scars ; on the lower side with numerous thin, brittle, 
Hght-colored roots about 4 inches (10 Cm.) long; the rhizome 
internally with a whitish wood and a pith which is usually dark 
colored or decayed; odor somewhat aromatic; taste sweetish, 
bitter, and pungent. 

It contains a volatile alkaloid, \y/?^^//;^^, which is the active 
principle. 

Dose. — J-2 drachms (1.0-8.0 Gm.). 

Official Preparation. 

ExtrSctum Spigeliae Fltiidum— Extr^cti Spigelise Fliiidi — Fluid Extract 
of Spigelia. — Dose, \-2 fluidrachms (1.0-8.0 Cc). 

Physiological Action and Therapeutics. — Spigelia is a pow- 
erful anthelmintic, being a decided vermifuge against the Ascaris 
lumbidcoidcs. When given alone and in full doses it may produce 
symptoms of narcotic poisoning. This may be obviated by asso- 
ciating it with cathartics and aromatics. 

The drug may be administered in the form of a tea, associated 
with senna, fennel, or other aromatics. The fluid extract is a reli- 
able preparation. 

Remedies employed against the different varieties of Tcenia : 
Aspidium— AspTdii— Aspidium. U, S. JP. 

(Male Fern.) 
Origin. — The rhizome of Dryopteris Filix mas Schott and of 
Dryopteris marginalis Gray, plants indigenous in North America, 



700 A TEXT-BOOK OF MATERIA MEDIC A. 

a portion of South America, Asia, Europe, and some parts of 
Africa, 

Description and Properties. — From 3 to 6 inches (7 to 15 Cm.) 
long, "I" to I inch (12 to 25 Mm.) thick, and, together with the 
closely imbricated, dark-brown, roundish, and slightly curved 
stipe-remnants, 2 to 3 inches (50 to 75 Mm.) in diameter; densely 
covered with brown, glossy, transparent, and soft, chaffy scales ; 
internally pale green, rather spongy ; vascular bundles about ten 
{Dryopteris Filix mas) or six (Dryopteris marginalis) in number, 
arranged in an interrupted circle ; odor slight, but disagreeable ; 
taste sweetish, acrid, somewhat bitter, astringent, and nauseous. 
Aspidium contains filicic acid, tannaspidic acid, pteritannic acid, 
filicin (filicic acid anhydride), fixed oil, a trace of volatile oil, and 
chlorophyl. 

Dose. — J-2 drachms (2.0-8.0 Gm.). 

Official Pj^eparation. 

Oleoresina Aspidii — Oleoresinse Aspidii — Oleoresin of Aspidium. — Dose, 
i-l fluidrachm (1.0-4.0 Cc). 

Note. — Oleoresin of aspidium usually deposits, on standing, a granular crystalline 
substance. This should be thoroughly mixed with the liquid portion before use. The 
oleoresin should be kept in well-stoppered bottles. 

Physiological Action and Therapeutics. — Aspidium is the 
most reliable tceniacide known to materia medica. Though it is 
employed against both the armed and unarmed varieties of tape- 
worm, it is nevertheless against the latter that it is specially effec- 
tive. In the cases of armed taeniae special precautions must be 
taken to ensure success. 

The drug possesses tonic and astringent properties, and if taken 
in very large doses may occasion nausea, vomiting, diarrhea, and 
gastric and abdominal pains. 

Several fatal cases of poisoning have occurred, and it is believed 
that the fatalities were due not so much to excessive dose as to 
increased absorption of the drug through the influence of the 
castor oil that had been administered with it. 

When given for the expulsion of tape-worm the bowels should 
first be emptied by a castor-oil purge, and then the oleoresin be 
administered in gelatin capsules or in emulsion. 

Previous to the exhibition of the anthelmintic the patient should 
for at least twenty-four hours live on exceedingly spare diet, and 
the medicine then be given in the morning fasting. A few hours 



ANTHELMINTICS. /OI 

later an active purge of about i ounce (30.0 Cc.) of castor oil or 
calomel and jalap should be given to expel the dead worm, which 
should be carefully examined for the head. If the head did not 
pass, the treatment should be repeated the following day or soon 
after. 

Cusso— Cusso— Kousso. V, S. JP. 

(Brayera.) 

Origin. — The female inflorescence of Hagenia Abyssinica (Bruce) 
Gmelin, a handsome tree 40 to 50 feet (12 to 18 M.) high, in- 
digenous on the table- land and in the mountainous districts of 
Abyssinia. 

Description and Properties. — In bundles, rolls, or compressed 
clusters consisting of panicles about 10 inches (25.0 Cm.) long, 
with a sheathing bract at the base of each branch ; the two round- 
ish bracts at the base of each flower and the four or five obovate 
outer sepals are of a reddish color, membranous and veiny ; calyx 
top-shaped, hairy, enclosing two carpels or nutlets ; odor slight, 
fragrant, and tea-Hke ; taste bitter, acrid, and nauseous. 

It contains a neutral active principle, kosin, a tasteless and an 
acid resin, and about 24 per cent, of tannin. 

Dose. — '1-4 drachms (4.0-16.0 Gm.). 

Official Preparation. 

ExtrSctum Ciisso Fluidum — ExtrScti Ctisso Fluidi — Fluid Extract of 
Cusso. — Dose, I-4 fluidrachms (4.0-15.0 Cc). 

Kosin — Koussein (unofficial). — Origin. — The active principle from the flowers 
and unripe fruits of Hagenia Abyssinica (Bruce) Gmelin. 

Description and Properties. — An amorphous yellowish crystalline powder having a 
pungent bitter taste. Insoluble in water, but readily soluble in alcohol and in ether. 

Dose., 15-30 grains (1.0-2.0 Gro.), to be divided into four doses and taken at inter- 
vals of half an hour. 

Physiological Action and Therapeutics. — The action of kousso 
upon the digestive tract, under large doses, is similar to the action 
of aspidium. It is a reliable anthelmintic for all species of tape- 
worm. The fluid extract should be given in the form of an emul- 
sion, the patient having previously fasted, and the exhibition of the 
drug followed in a few hours by a large dose of castor oil. 

Granatum—Granati— Pomegranate. 77. ^* P« 

Origin. — The bark of the stem and root of Piinica Granatum 
L., a shrub or small tree about 20 feet (6 M.) high, indigenous 
in Southwestern Asia from Northern India to Palestine. 



702 A TEXT-BOOK OF MATERIA MEDICA. 

Description and Properties. — In thin quills or fragments from 
2 to 4 inches (5 to 10 Cm.) long and from -^^ to \ inch (i. to 3. 
Mm.) thick ; outer surface yellowish-gray, somewhat warty or 
longitudinally and reticulately ridged ; the stem-bark often partly 
covered with blackish lichens ; the thicker pieces of the root-bark 
more or less scaly externally ; inner surface smooth, finely striate, 
grayish-yellow; fracture short, granular, greenish-yellow, indis- 
tinctly radiate ; inodorous ; taste astringent, very slightly bitter. 

It contains as its active constituent a liquid alkaloid, pelletierine, 
with its three allied alkaloids, methyl-pelletierine , pseudo-pelletieriney 
and iso-pelletierine, besides mannite and punico-tannic acid. 

Dose. — J-iJ drachms (2.0-6.0 Gm.). 

Unofficial Preparations. 

Pelletierine. — Origin. — An alkaloid derived from the root-bark of Punica grana- 
tum L. 

Description and Properties. — A colorless liquid. Soluble in 20 parts of water and 
miscible in all proportions with alcohol. It forms crystalline salts with acids, the prin- 
cipal one being the tannate. 

There are also the sulphate, hydrobromate and hydrochlorate. 

Pelletierinae Talmas — Pelletierlnae Tannatis — Pelletierine Tannate. — De- 
scription and Properties. — A yellowish, hygroscopic, odorless powder, with a pungent 
astringent taste. Soluble in 700 parts of water and in 80 parts of alcohol. 

Dose.—\-^ grains (0.06-0.32 Gm.). 

Physiological Action and Therapeutics. — Locally pomegran- 
ate is astringent. In large doses it excites vomiting, acts as a 
purgative, paralyzes the motor nerves, but does not affect sensa- 
tion, and dilates the capillaries. 

Pomegranate and its alkaloid, pelletierine, are efficient anthel- 
mintics for tape-worm. 

Like other anthelmintics, the drug should be given on an empty 
stomach, and if the bowels are not freely moved by the remedy, an 
active cathartic should follow its administration. 

A decoction of the bark may be used, but, owing to the diffi- 
culty in obtaining the fresh drug, which alone possesses anthel- 
mintic properties, the tannate of pelletierine, which is always 
reliable, is usually administered. 

Kamala— Kamalae— Kamala. JJ. S. JP. 

(ROTTLERA.) 

Origin. — The glands and hairs from the capsules of Mallotus 
Philippine7tsis (Lamarck) Mueller, Arg., a large shrub or small tree 



ANTHELMINTICS. 703 

growing wild in Australia, Eastern China, India, Southern Arabia, 
and Abyssinia. 

Description and Properties. — A granular, mobile, brick-red or 
brownish-red powder, inodorous and nearly tasteless, imparting a 
deep-red color to alkaline hquids, alcohol, ether, or chloroform, 
and a pale yellow tinge to boiling water. Under the microscope it 
is seen to consist of stellately arranged, colorless hairs, mixed with 
depressed-globular glands, containing numerous red, club-shaped 
vesicles. It contains a resinous coloring matter, rottleriit^ and 
several resins. 

Dose. — 1-2 drachms (4.0-8.0 Gm.). 

Physiological Action and Therapeutics. — Kamala is a gastro- 
intestinal irritant and purgative, and an efficient anthelmintic against 
the TcBJtia solium, as well as the Oxyurisvermicularis and the Ascaris 
lumbricoides. The drug should be taken suspended in syrup, and 
followed by a full dose of castor oil. 



Pepo—Peponis— Pumpkin Seed. JJ, S. IP. 

Origin. — The seed of Ciicurbita Pepo L., the common pumpkin, 
indigenous in tropical Asia and America, and cultivated through- 
out the temperate zones. 

Description and Properties. — About f inch (2 Cm.) long, 
broadly-ovate, flat, white or whitish, nearly smooth, with a shallow 
groove parallel to the edge ; containing a short, conical radicle and 
two flat cotyledons ; inodorous ; taste bland and oily. It contains 
an acrid resin, supposed to be the active principle, and from 30 to 
35 per cent, of a thick red fixed oil. 

Dose. — 1-3 ounces (32.0-94.0 Gm.). 

Physiological Action and Therapeutics. — Pumpkin seed ranks 
next to aspidium as a remedy for the destruction of tape-worm, 
and has the advantage of being free from any disagreeable taste or 
unpleasant action. For administration the fresh pumpkin seeds 
should be beaten into a paste with powdered sugar and diluted 
with milk or water to about i pint (473.17 Cc). Previous to its 
administration the patient should fast for twenty-four hours, when 
the bowels should be flushed out with a large saline purgative. 
A portion of the emulsion of pumpkin seed is then to be taken, 
preferably in the morning, and the balance taken in two doses at 
intervals of about two hours, the patient meanwhile remaining in 
bed to prevent, as far as possible, disturbance of the stomach. 



704 



A TEXT-BOOK OF MA TERIA MEDICA. 



Three or four hours after the last dose of the emulsion has been 
taken the patient should be given a full dose of castor oil. 



GROUP XVI.— EMMENAGOGUES AND ECBOLICS. 

Emmenagogues are remedies which restore or increase the men- 
strual flow. They are divided, according to their action, into two 
classes. Those which act upon the uterine muscle or mucous 
membrane are said to be direct ; those which influence the uterus 
by affecting the general health of the body, or by altering the 
blood-supply of the parts, or by influencing the nervous system, 
are said to be indirect. 

The principal Direct Emmenagogues are- 
Ergot, Borax, 
Digitalis, Rue, 
Savine, Hydrastis, 
Quinine, Caulophyllum, 
Asafetida, Tansy, 
Myrrh, Apiol, 
Guaiac, Hedeoma. 
Cantharides, 
The Indirect Emmenagogues are — 

Iron and the Hematics, Cinnamon, 

Cod Liver Oil, Aloes, 

Strychnine, 

( Hot foot-bath. 
Baths \ Hot hip-bath. 
I Mustard bath. 

T , f To genitals. 
Leeches S ^ , . , 

(. To thighs. 

C Baths. 
Mustard < Poultices to thighs. 
I Stupes. 
EcBOLics or Oxytocics are remedies which act directly upon the 
uterine muscular fibers, inducing uterine contraction, and are chiefly 
used during or immediately after parturition to produce or increase 
uterine action. They are therefore contraindicated before parturi- 
tion, lest they induce abortion, although they are often used crimi- 
nally for this purpose. 

The exact manner in which ecbolics act is unknown, but it is 



EMMENAGOGUES AND ECBOLICS. 705 

« 

supposed that they act directly by stimulating the uterine center 
in the cord or reflexly through uterine congestion. 

In small doses many of the ecbolics are emmenagogue, while 
many of the direct emmenagogues are ecbolic. 

The only justifiable uses for ecbolics are in parturition, with 
uterine inertia and unobstructed and well-dilated maternal parts, 
when it is desired to hasten the delivery of the child, or, second, 
to induce firm contraction of the uterus, and thus prevent or check 
uterine hemorrhage after the birth of the child. 
The principal Ecbolics are — 

Ergot, Oil of Rue, 

Ustilago, Borax, 

Hydrastis, Pilocarpine, 

Savine, Potassium Permanganate, 

Quinine, Strong Purgatives. 

Cotton Root Bark, 

Drugs which have not been considered elsewhere in the present 
work will now be described. 

Sablna—Sablnae— Savine. TJ, S. IP. 

Origin. — The tops of Juniperus Sabina L., a small ever- 
green procumbent or erect shrub, distributed throughout the 
greater portion of Europe, Siberia, Canada, and the Northern 
United States. 

Description and Properties. — Short, thin, subquadrangular 
branchlets ; leaves rather dark green, in four rows, opposite, scale- 
like, ovate-lanceolate, more or less acute, appressed, imbricated, 
on the back with a shallow groove containing an oblong or round- 
ish gland ; odor peculiar, terebinthinate ; taste nauseous, resinous, 
and bitter. 

It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. 

Dose. — 5-15 grains (0.3-1.0 Gm.). 

Official Preparation. 

Extractum Sabinae Fluidum — ExtrScti Sablnae Fluidi — Fluid Extract of 
Savine. — Dose, 5-15 minims (0.3-1.0 Cc). 

Oleum Sabinae— Olei Sablnae— Oil of Savine. 

TJ. S. JP. 

Origin. — A volatile oil distilled from Savine. 
Description and Properties. — A colorless or yellowish liquid 
45 



7o6 A TEXT- BOOK OF MATERIA MEDIC A. 

having a peculiar terebinthinate odor and a pungent, bitterish, and 
camphoraceous taste. It becomes darker and thicker by age and 
exposure to the air. Soluble in an equal volume of alcohol. 

Dose. — 1-5 minims (0.06-0.3 Cc). 

Physiolog-ical Action and Therapeutics. — The action of savine 
depends on the presence of the volatile oil, and this oil differs in 
its local external effect from the oil of turpentine merely in that 
the oil of savine is more active. It occasions much irritation, vesi- 
cation, and even pustulation when applied to the skin. Taken 
internally in small doses, it produces a sensation of heat in the 
epigastrium, with flatulence and frequently nausea. Toxic doses 
excite violent gastro-enteritis. 

The drug stimulates the circulation, and later, under full me- 
dicinal doses, depresses it. It is rapidly absorbed, and is excreted 
by various channels, increasing the urinary and bronchial excre- 
tions. These excretions, as well as the sweat and breath, smell 
strongly of the drug. 

Savine is a decided irritant to the uterus and ovaries, inducing 
marked hyperemia of those organs, and promoting contractions of 
the pregnant uterus. 

Toxic doses produce symptoms similar to those occasioned by 
oil of turpentine — violent gastro-enteritis, suppressed or bloody 
urine, great depression, etc. The treatment in poisoning by oil of 
savine would be full doses of Epsom salt, demulcents, anodynes, 
and stimulants if necessary. 

Savine in the form of an ointment is used as a stimulant appli- 
cation to keep up the discharge from bhsters. An alcoholic solu- 
tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to i ounce (30.0 
Cc), is used in alopecia pityroides. 

Oil of savine is a very efficient remedy in amenorrhea, and is 
also of benefit in certain cases of menorrliagia due to an enlarged 
and passively congested uterus. The hemorrhage following abor- 
tion is usually well controlled by this remedy. 

The powder or fluid extract may be given, but the oil is the 
most effective preparation, and may be prescribed in capsules, pills, 
or emulsion. It should be given cautiously. 

Ruta— Rutae— Rue. (Unofficial.) 

Origin. — The leaves of Rttta gravcolcns L., an herbaceous or 
suffruticose perennial 2 or 3 feet (60 or 90 Cm.) high, indigenous 
in Southern Europe. 



EMMENAGOGUES AND ECBOLICS 



707 



Description and Properties. — The leaves are ternate, the leaf- 
lets being obovate-oblong, yellowish-green, thickly dotted with 
minute, transparent oil-vesicles. They have a peculiar, strongly 
balsamic odor, and possess an aromatic, bitter, and acrid taste. 

The principal constituent of rue is a volatile oil. 

Dose. — 5-20 grains (0.3-1.3 Gm.). 

Oleum Rutae— Olei RQtae— Oil of Rue. (Unofficial.) 

Origin. — A volatile oil distilled from Riita grave oleiis L. 

Description and Properties. — A colorless or greenish-yellow 
liquid with the peculiar odor of the plant, and a pungent, some- 
what acrid, bitterish taste. Soluble in an equal weight of alcohol. 

Dose. — 2-5 minims (0.13-0.3 Cc). 

Physiolog-ical Action and Therapeutics. — The action of oil 
of rue is analogous to that of oil of savine, though less powerful. 
It is used for the same purposes also, and has occasionally been 
employed in hysteria. 

The oil should be administered in capsules. 

Caulophyllum— Caulophylli— Caulophyllum. 
U. S.JP. 

(Blue Cohosh.) 

Origin. — The rhizome and roots of Catdophyllum Thalictroides 
(L.) Michaux, a smooth and glaucous perennial, found in rich 
woodlands from Canada south to Carolina and Kentucky. 

Description and Properties. — Rhizome of horizontal growth, 
about 4 inches (10 Cm.) long and about ^ to f inch (6 to 10 Mm.) 
thick, bent ; on the upper side with broad, concave stem-scars 
and short, knotty branches ; externally grayish-brown, internally 
whitish, tough, and woody. Roots numerous, matted, about 4 
inches (10 Cm.) long and -^-^ inch (i Mm.) thick, rather tough; 
nearly inodorous ; taste sweetish, slightly bitter, and somewhat 
acrid. 

Caulophyllum contains an odorless, colorless, and tasteless alka- 
loid, c aid ophy Hill, besides resins, tannin, starch, gum, etc. 

Dose. — 5-30 grains (0.3-2.0 Gm.). 

Physiological Action and Therapeutics. — Blue cohosh is em- 
menagogue, antispasmodic, diuretic, and demulcent. It is quite an 
efficient remedy to increase the force of uterine contractions, and 
is of service in the treatment of spasmodic dysmenorrhea. 

It is usually given in the form of a decoction. 



1 



7o8 A TEXT-BOOK OF MATERIA MEDIC A. 

Tanacetum—Tanaceti— Tansy. U. S. JP. 

Origin. — The leaves and tops of Tanacetwn vulgare L., a 
perennial herb indigenous in Europe and Central Asia, and nat- 
uralized in many parts of North America. 

Description and Properties. — Leaves about 6 inches (15.24 
Cm.) long, bipinnatifid, the segments oblong, obtuse, serrate, or 
incised, smooth, dark green, and glandular; flower-heads corym- 
bose, with an imbricated involucre, a convex, naked receptacle, and 
numerous yellow tubular florets ; odor strongly aromatic ; taste 
pungent and bitter. 

It contains a volatile oil and a bitter principle, tanacetin, besides 
tannin, resin, etc. 

Dose. — 15-60 grains (1.0-4.0 Gm.), in infusion. 

Physiolog'ical Action and Therapeutics. — In moderate doses 
tansy acts as an aromatic bitter. Excessive amounts produce all 
the symptoms of an irritant narcotic — vomiting, purging, severe 
abdominal pain, loss of consciousness, convulsions, and great car- 
diac and respiratory weakness, death usually resulting from paral- 
ysis of respiration. 

The drug is regarded as an efficient remedy in amenorrhea, and 
is extensively employed in domestic practice in hysteria and colicy 
and topically for bruises, sprains, muscular rheumatism, etc. 

It is used in the rural districts to promote or restore menstrua- 
tion, and occasionally is employed with criminal intent as an abor- 
tifacient, but usually with negative results. 

The drug may be given in the form of an infusion, i ounce to 
I pint (32.0 Gm.-473.17 Cc), of which i or 2 ounces (30.0 or 60.O 
Cc.) may be taken at a dose. 

The oil of tansy is occasionally prescribed in doses of 1-5 
minims (0.06-0.3 Cc). 

PetroselTnum—Petrosellni— Parsley. 

Origin. — The root of Petroselinuni sativum (Hoffmann), Apium 
Petj'oselinum L., a plant indigenous in Southern Europe, and much 
cultivated for culinary purposes. 

Description and Properties. — The root is tapering, from 4 to 
8 inches (10-20 Cm.) long, about \ inch (12 Mm.) thick; exter- 
nally yellowish or light brown ; odor aromatic ; taste sweetish and 
aromatic. 

It contains a volatile oil and apiol, the chief constituent. 

Dose. — 30-60 grains (2.0-4.0 Gm.). 



EMMENAGOGUES AND ECBOLICS. 709 

Apiolum — Apidli — Apiol (Unofficial). — Origin. — A camphor obtained from the 
fruit of Petroselinum sativtwi Hoffmann. 

Description and Properties. — White needles, of a feeble, parsley odor. Insoluble 
in water, but freely soluble in alcohol and in ether. 

Dose. — 10-15 grains (0.6-1.0 Gm.). 

Physiolog'ical Action and Therapeutics. — The root is carmin- 
ative, laxative, and diuretic. Apiol is an active emmenagogue. 
Given in excessive doses, it occasions severe frontal headache, 
dizziness, and ringing in the ears. It causes a rapid rise of blood- 
pressure, due to increased cardiac action and stimulation of the 
vaso-motor centers. 

Apiol, or Chapoteaut's apioline, is usually prescribed, and is 
an efficient remedy in amenorrhea, dysmenorrhea, and as an anti- 
periodic in malarial affections. As an emmenagogue in cases of 
scanty or deficient menstruation apioline is very effective. 

The drug is best given in capsules, as prepared by Chapoteaut,^ 
one or two capsules being taken after meals three times a day. 

Hedeoma— Hedeomae— Hedeoma. V. S. JP. 

(Pennyroyal.) 

Origin. — The leaves and tops of Hedeoma pulegioides (L.) Per- 
soon, an annual herb indigenous in North America. 

Description and Properties. — Leaves opposite, short-petioled, 
about \ inch (12 Mm.) long, oblong-ovate, obscurely serrate, glan- 
dular beneath ; branches roundish-quadrangular, hairy ; flowers in 
small, axillary cymules, with a tubular-ovoid, bilabiate, and five- 
toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing 
two sterile and two fertile exserted stamens ; odor strong, mint-like ; 
taste warm and pungent. Its virtues depend upon a volatile oil. 

Dose. — 15-60 grains (1.0-4.0 Gm.) in infusion. 

Oleum Hedeomae— Olei Hedeomae— Oil of Hede- 
oma. 77. H, JP. 

(Oil of Pennyroyal.) 

Origin. — A volatile oil distilled from Hedeoma. 
Description and Properties. — A pale-yellowish, limpid liquid, 
having a characteristic, pungent, mint-like odor and taste. It should 

1 M. Chapoteaut has prepared from the alcoholic solution of a petrol-ethereal extract 
a thick reddish liquid, to which he has given the name Apioline. This substance he 
claims to be the true active principle, and it is dispensed in capsules containing 3 minims 
(0.18 Cc.) each. 



7IO A TEXT-BOOK OF MATERIA MEDICA. 

be kept in well-stoppered bottles, in a cool place, protected from 
light. 

Dose. — 2-iQ minims (0.1-0.6 Cc). 

Physiolog-ical Action and Therapeutics. — Hedeoma is aro- 
matic, stimulant, carminative, and emmenagogue, while the oil is 
rubefacient if rubbed into the skin. 

The herb is given in the form of a hot infusion to bring on 
retarded or suspended menstruation and for the relief oi flatulent 
colic, pharyngitis, bronchitis, etc., as well as to dissipate congestions 
of various parts. 

The OIL OF HEDEOMA is an active emmenagogue, and is used 
to increase the rubefacient effect of various embrocations. 



GROUP XVIL— ASTRINGENTS. 

Astringents are medicines which cause the contraction of living 
tissues, diminishing the amount of blood or other fluid in them, and 
reducing hemorrhage, or, through their constipating action, limiting 
the intestinal secretions as well as those from mucous membranes 
generally. 

They act chemically upon the tissues, and, when taken inter- 
nally, their influence is similar to that of tonics, invigorating the 
various structures of the body, their principal use being, in cases 
of relaxed conditions of the muscles and fibers or of the mucous 
membranes characterized by excessive secretion. 

Astringents are more or less irritating, and should therefore not 
be employed, as a rule, in acute inflammatory conditions. There 
are, however, four exceptions — lead acetate or subacetate, bismuth 
subnitrate or subcarbonate, cerium oxalate, and silver nitrate — 
which are sedative astringents and would be indicated in acute 
inflammatory states. 

Astringents vary in the intensity of their action, their strength 
being directly proportionate to the condensation of tissue. Herein 
lies the chief difference between astringents and caustics. If the 
heavy metals be arranged according to their astringent properties, 
the feeblest at one extreme and the strongest at the other, it will 
be observed that the least astringent is the most caustic, and the 
most astringent the least caustic, the order being as follows : lead 
{astringent^, iron, zinc, copper, silver, tin, mercury [caustic^, lead 
being the most astringent and least caustic, and mercury the most 
caustic and least astringent. 



ASTRINGENTS. 71 1 

The explanation of these diverse properties is that the astrin- 
gents expel the fluid from the protoplasm, contracting or constring- 
ing the tissue and causing it to occupy less space ; whereas the 
caustics relax the eschar, reducing the space it occupies. The 
caustic action of a mineral salt depends both upon the nature of 
the base and the acid radical. In other words, the salt and the 
products of its action must both be somewhat soluble in water, 
otherwise the eschar will be firm, and the drug will therefore act 
as an astringent. 

The chlorides of the heavy metals are usually soluble, and are 
generally the more caustic, as, for instance, zinc chloride, mercuric 
chloride (corrosive sublimate), etc. Should a chloride be insoluble 
in water, it will not act as a caustic — as, for example, the insoluble, 
and consequently inert, silver chloride. 

Certain drugs which in a concentrated state are caustic are, if 
sufficiently diluted, astringent, as is the case with sulphuric acid. 
An astringent drug employed to check hemorrhage is called a 
styptic, the subsulphate of iron being extensively used as such. 

Astringents differ in some respects from other groups of medi- 
cines, in that they do not, as a rule, assist one another by combi- 
nation. They are divisible into — (i) Vegetable astringents ; (2) 
mineral astringents. The vegetable astringents mentioned in this 
group, beginning with the type, are — 

Tannic Acid, Kino, Rhus Glabra, 

Gallic Acid, Krameria, Rosa Gallica, 

Galla, Hematoxylon, Rubus. 

Quercus Alba, Hamamelis, 

Catechu, Geranium, 

Cinnamon also possesses considerable astringent properties, but 
is classed among the Aromatics. 

The mineral astringents, beginning with the type, are — 
Lead, Silver, Bismuth, 

Zinc, Alum, Cerium Oxalate. 

Copper, 

Certain salts of iron are powerfully astringent, although classed 
with iron under the Restoratives. Diluted sulphuric and nitric acids 
also possess marked astringent properties. (See Mineral Acids.) 

Antagonists and Incompatibles. — The vegetable astringents 
are incompatible with the salts of iron (ferric and ferrous), and also 
with the salts of lead, silver, antimony, and copper ; with the alka- 



712 A TEXT- BOOK OF MATERIA MEDIC A. 

loids, the glucosids, and gelatin ; and with the alkaHes and mineral 
acids and emulsions. Spirit of nitrous ether is incompatible with 
galHc acid. 

Synerg-ists. — Tonics and bitters, and also agents increasing 
waste, favor the action of vegetable astringents. 

VEGETABLE ASTRINGENTS. 

Acidum Tannicum— Acidi Tannici— Tannic Add. 

77. H. jP. 

Origin. — An organic acid obtained from Nutgall. 

Description and Properties. — A light-yellowish, amorphous 
powder, usually cohering in the form of glistening scales or spongy 
masses ; odorless or with a faint characteristic odor and a strongly 
astringent taste ; gradually turning darker when exposed to air and 
light. Soluble in about i part of water and in 0.6 part of alcohol ; 
very soluble in boiling water and in boiling alcohol ; also soluble 
in about i part of glycerin with the assistance of a moderate heat ; 
freely soluble in diluted alcohol and sparingly in absolute alcohol ; 
almost insoluble in absolute ether, chloroform, benzol, or benzin. 

Dose. — 1-20 grains (0.06-1.2 Gm.). 

Official Preparations. 

Collodium Stypticum — CoUodii Styptici— Styptic Collodion. — Used exter- 
nally and locally. (Tannic Acid, 20; Alcohol, 5; Ether, 25; Collodion, to 100.) 

Glyceritum Acidi Tannici — Glyceriti Acidi Tannici — Glycerite of Tannic 
Acid. — Used externally and locally. (Tannic Acid, 20; Glycerin, 80.) 

Trochisci Acidi Tannici — Trochiscos (ace.) Acidi Tannici — Troches of 
Tannic Acid. — Dose, i to 3 troches. 

UnguSntum Acidi TSnnici — UnguSnti Acidi TSnnici — Ointment of Tannic 
Acid. — Used externally and locally. (Tannic Acid, 20; Benzoated Lard, 80.) 

Physiological Action. — Externally. — Tannic acid has little if 
any effect upon the unbroken skin. Upon raw surfaces, however, 
it acts as a powerful astringent, contracting the tissues and coagu- 
lating the albumin. Urticaria and erythema sometimes follow its 
use. 

Internally. — Digestive System. — By coagulating the albumins 
tannic acid imparts a dryness to the mouth, accompanied by a sen- 
sation of puckering. It partially paralyzes the sensory nerve- 
endings, thus blunting the sense of taste. Large doses produce 
vomiting by an irritant action, while diarrhea, followed by consti- 
pation, may be present. 



ASTRINGENTS. 713 

By its action on the stomach pepsin is precipitated, albumin co- 
agulated, and the secretion of gastric juice diminished, all of which 
actions tend to impair the digestive function. There is a partial 
conversion of the tannic acid into gallic and pyrogallic acids. To 
facilitate absorption there must be a preliminary conversion of 
tannic into gallic acid, and this reaction takes place in the intestine. 
A diminution of peristalsis is followed by constipation. 

Circulatory System. — Its astringent property makes tannic acid 
a valuable hemostatic. It arrests hemorrhage by contracting the 
blood-vessels. The blood absorbs it as gallic acid, and is not 
affected by it. 

Nervous System, — No special effect has been observed. 

Respiratory System. — Save in arresting hemorrhage of the lungs, 
no influence is known. 

Absorption and Elimination. — Being absorbed as gallic acid, the 
kidneys ehminate it in that form. A doubtful action ascribed to it 
by some authorities is that of diminishing albuminuria. 

Uterus. — No special influence other than arresting hemorrhage 
has been noted. 

Untoward Action. — A dose of 3 grains (0.2 Gm.) may cause 
pain in the stomach and intestines. Following such a dose, there 
may be coating of the tongue, thirst, eructation of gas, and tenes- 
mus. A tendency to hemorrhoidal congestion is enhanced. 

Therapeutics. — Externally and Locally, — Tannic acid is a val- 
uable application for bed-sores and ulcers. Its astringent property 
is of use in cases of intertrigo, impetigo, sycosis, sore nipples, and 
eczema of the chronic, desquamating variety. It is beneficial in 
hyperidrosis of the hands and feet, of the axillcE and genitals. A 
solution of the acid has been found of advantage in erysipelas and 
lymphangitis. 

The GLYCERITE OF TANNIN, applied locally in cases of otorrhea 
and ozena as sequelae of scarlet fever or measles, is of great benefit. 
The same preparation or a powder may be used in stomatitis, ton- 
sillitis, and pharyngitis, as well as in cases of spongy or tdcerous 
gums. The lozenges are beneficial in whooping cough. Sup- 
positories OF tannic acid are employed for hemorrhoids, fissure, 
prolapse, and rectal tdcers. 

An AQUEOUS solution of tannic acid is very useful in leucor- 
rhea. The glycerite and iodoform tannin are excellent agents in 
inflammation of the cervix uteri. Tannic acid also dispels the odor 
and allays the discharges in carcinoma uteri, being applied as a 



714 A TEXT-BOOK OF MATERIA MEDICA. 

vaginal douche. It is useful as a lotion in herpes and alopecia cir- 
cumscripta. Injection of the acid or insufflation of the powder into 
the urethra is of some value in gonorrJiea. In hemoptysis an aque- 
ous solution (5-10 grains to the ounce of water) may be used as 
a spray. In acute dysejttery much benefit may be derived from 
an enema of 10 grains of tannin added to a 4 per cent, solution of 
boric acid. It lessens pain and tenesmus and controls hemorrhage. 

Internally. — For other than local action gallic is preferable to 
tannic acid, the latter not being absorbable. Tannic acid is styptic 
in Jiematemesis and intestinal hemorrhage and checks diarrhea. It 
forms tannates when given as an antidote for poisoning by alkaloids 
and tartar emetic. Since these tannates are more or less soluble, 
however, some drug should be given as a purgative. 

Contraindications. — From comparative absorbability of tannic 
and galHc acids the former is preferable for local, the latter for 
systemic, effects. 

Administration. — For hematemesis powders of 10-20 grains 
are given. For effect upon the intestines it should be administered 
in pills, 3-5 grains, or it may be dissolved in the stomach. Locally 
it may be applied as a solution, glycerite, powder, suppository, or 
an ointment. Styptic collodion is a protection to lacerated or 
incised wounds. 

Acidum Gallicum— Acidi Gallici— Gallic Acid. 

U. S. JP. 

Origin. — An organic acid usually prepared from Tannic Acid. 

Description and Properties. — White or pale fawn-colored,, 
silky, interlaced needles or triclinic prisms ; odorless, having an 
astringent or slightly acidulous taste ; permanent in the air. Sol- 
uble in 100 parts of water and in 5 parts of alcohol. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Physiological Action. — Gallic acid resembles tannic acid in 
its action, but does not coagulate albumin, and therefore does not 
possess the local influence of the latter. It is eliminated by the 
kidneys as gallic acid. 

Therapeutics. — Externally and Locally. — -Gallic acid is seldom 
used externally. Locally, tannic acid is preferable, but gaUic acid 
is effectual applied as a glycerite, i drachm- 1 ounce (4.0-32.0 Gm.),. 
in cases of tonsillitis and pharyjigitis. Gallic acid and stramonium 
ointment in equal parts form an unguent for hemorrhoids. In 
alcoholic solution it is applied to the membrane of diphtheria. 



\ 



ASTRINGENTS. 715 

Internally. — Gallic acid is chiefly serviceable in hemorrhage from 
the stomachy intestines, lungs, and kidneys. It is employed in tnen- 
orrhagia, but ergot is better. It reduces albumin in some forms 
of Bright s disease, and is useful in checking excessive sweating and 
bronchorrhea. In chronic phthisis it relieves the ?iight-sweats and 
reduces profuse expectoration. Cystitis, dysentery, and chronic diar- 
rhea are benefited by its use. It checks suppuration and stays the 
progress of pyelitis and pyelo-nephritis. Used in conjunction with 
opium, it has been found beneficial in diabetes iyisipidus. 

Pyrogallic acid is of use in acne, but produces a discoloration 
of the skin. 

Pyrogallol, 2 grains (.12 Gm.), is used in internal hemorrhage. 
As an ointment, i drachm-i ounce (4.0-32.0 Gm.), it is palliative 
in psoriasis, and it is also beneficial in lupus and epithelioma. 

Gallanol, the analid of gallic acid, is a bactericide, and is use- 
ful m psoriasis in the form of a powder or in an ointment (i to 30). 
It is also used in alcoholic solutions of 10 per cent, strength. It 
relieves the pruritus of clironic eczema. \\\favus and tricophytosis 
a mixture is used consisting of gallanol 10 parts, ammonia i part, 
and alcohol 50 parts. 

Gallicine, methyl ether of gallic acid, applied in finely divided 
form with a brush, is of benefit in keratitis and conjunctivitis, as 
well as in eczema of the eyelids. 

Administration. — Gallic acid is not to be combined with iron. 
It is administered in powder or pill form. The glycerite and the 
ointment are used locally. 

Galla-Gallae-Nutgall. 77. H. P. 

Orig'in.^An excrescence on Quercus Lusitanica Lamarck, caused 
by the punctures and deposited ova of Cynips gallcz ti7ictori(B 
Olivier. 

Quercus Lusitanica is a small tree, or oftener a shrub, 4 to 6 
feet ( 1. 2-1. 8 M.) high, indigenous in the basin of the Mediter- 
ranean. 

Description and Properties. — Nutgalls are subglobular, about 
I inch (25 Mm.) in diameter, more or less tuberculated above, 
otherwise smooth, heavy, hard ; often with a circular hole near 
the middle communicating with the central cavity containing either 
the partly developed insect or pulverulent remains of it ; inodor- 
ous ; taste strongly astringent. 

Galla in substance is seldom given internally. 



1 



7l6 A TEXT-BOOK OF MATERIA MEDICA. 

Official Preparations. 

Tinctura Gailae— Tincturae GSllae — Tincture of Nutgall.— Z>oj^, i to 2 fluid- 
drachms (4.0-8.0 Gm.). 

UnguSntum G^lla — UnguSnti GSUae — Ointment of Nutgall. — Used exter- 
nally. 

Physiological Action. — Its action is that of tannic acid, which 
is derived from galls. 

Therapeutics. — Exter?tally arid Locally. — Galla, in combination 
with stramonium liniment or i drachm (4.0 Gm.) of powdered 
opium to each ounce (32,0 Gm.) of nutgall ointment, is an excellent 
application for external hemorrhoids. For eczema of the scalp, 
herpes, fissured nipples, indolent ulcers, and chilblains nutgall oint- 
ment has proved beneficial, as well as for alopecia circumscripta 
and rectal prolapse. One part of powdered galls to seven or eight 
of vaseline is a most excellent application for lessening the cica- 
tricial contraction following extensive burns. Galla is used little 
locally, but is recommended as a gargle and wash, being applied 
to the relaxed mucous membranes of the mouth, vagina, and 
rectum. 

Internally. — Tannic and gallic acids are preferable in severe 
diarrhea and dysentery, an infusion or decoction being used as an 
enema. 

Administration. — Galls are used mostly in the form of an 
infusion or ointment. The tincture is seldom employed. 

Qu^rcus Alba— Quercus Albae— White Oak. 

U. S. jP. 

Origin. — The bark of Quercus alba L. The oaks are shrubs 
or trees growing chiefly in the temperate zone, often forming exten- 
sive forests. The white oak is a stately tree, 60 to 80 feet (18-24 
M.) high, found from Canada to Florida and west to Wisconsin 
and Eastern Texas. 

Description and Properties. — In nearly flat pieces deprived of 
the corky layer, about \ inch (5 Mm.), pale brown ; inner surface 
with short, sharp, longitudinal ridges ; tough and of a coarse, 
fibrous fracture, a faint, tan-like odor, and a strongly astringent 
taste. As found in the shops, it is usually an irregularly coarse 
fibrous powder, which does not tinge the saliva yellow. 

Dose. — Seldom given in substance. A decoction is sometimes 
given internally, but the chief use of the drug is for external or 
local appHcation. 



ASTRINGENTS. 717 

Physiolog-ical Action. — The general action is that of tannic 
acid. 

Therapeutics. — Externally and Locally. — It is used for chapped 
nipples, gangrene, tdcers, and dermatitis venenata. It is of value 
as an ointment in henwrrlwids, prolapsus ani, anal fissure, and leii- 
corrhea. The drug is also serviceable in i^elaxed tivida and as a 
tooth-powder. It stains the linen, however, which somewhat limits 
its use. Pessaries made of the bark have been used to check 
uterine hemorrhage. For Jicrnia the concentrated fluid extract is 
injected into the tissues for the purpose of exciting inflammation 
and consequent contraction of the hernial ring. 

Internally. — It reduces bronchial discharge, hemoptysis, serous 
diarrhea, and dysentery. 

Administration. — Externally it is used as a poultice — chiefly 
in the form of the powdered bark. The decoction is employed 
almost exclusively as an injection and for internal administration. 
The laity were formerly wont to roast the acorns and chew them, 
or grate them and mix the gratings with cocoa or chocolate, 
believing them to be a cure for diarrhea as well as for flatulent 
dyspepsia and scrofula. 

Catechu— Catechu— Catechu. JJ, S. I*. 

Origin. — An extract prepared from the wood of Acacia catechu 
(Linn, fil.) Willd., a tree 30 to 40 feet (9-12 M.) high, indigenous 
in the East Indies and Ceylon. 

Description and Properties. — Occurring in irregular masses, 
containing fragments of leaves ; dark-brown, brittle, somewhat 
porous and glossy when freshly broken. It is nearly inodorous 
and has a strongly astringent and sweetish taste. 

Dose. — 10-30 grains (0.6-2,0 Gm.). 

Official Preparations. 

Tinctura CStechu Composita — Tincturae Catechu Comp6sitae — Compound 
Tincture of Catechu. — Dose, i- 2 fluidrachms (2.0-8.0 Cc). (Catechu, 100; Cassia 
Cinnamon, 50; by maceration and percolation with Dihited Alcohol to looo.) 

Trochisci Catechu — Trochiscos (ace.) Catechu — Troches of Catechu. — 
Dose, I to 6 troches. (Each troche contains i grain (0.06 Gm.) of catechu.) 

Physiolog-ical Action. — Catechu does not differ in its action 
from tannic acid. It is to be preferred to kino, however, since its 
operation is more energetic. 

Therapeutics. — Externally and Locally. — Though used but 
little externally, it is a very efficient remedy for ulcerated nipples 



7l8 A TEXT-BOOK OF MATERIA MEDICA. 

and chronic ulcers, the form employed being that of a lotion, used 
either alone or in combination with copper sulphate or alum. 
Catechu is of service in constringing relaxed tissues, and is used 
as a mouth-wash in spongy gums, ptyalism, and relaxation of the 
uvula. It is also of use as a gargle in pharyngitis and chronic sore 
throat of public speakers and users of tobacco. In gonorrhea and 
leucorrhea an injection of 2-3 drachms (8.0-12.0 Gm.) of the 
tincture in 5-6 ounces (160.0-192.0 Gm.) of water is beneficial. 

Catechu has been used by persons suffering from pyrosis. It is 
claimed that chewing a small pellet of the drug diminishes the 
coating of mucus on the mucous membrane of the stomach. It 
is applied to aphtlice in stomatitis. 

Internally. — Its prevailing use is in chronic serous diarrheas, 
but the administration must be preceded by a saline purge in 
order to secure the fullest effect. Catechu checks uterine heinor- 
rhage and the secretions in bronchitis and chronic phthisis. 

Administration. — The troche is best used in chronic pharyn- 
gitis and relaxed buccal mucous membranes, or a piece of the 
drug may be chewed with beneficial results. For diarrhea the 
compound tincture, with a little morphia or the official chalk 
mixture, is the best form for use. 

KTno— KIno~Kino. 77. S. JP. 

Origin. — The inspissated juice of Pterocarpus marsupianum 
Roxburgh, a tree (called buja in Bengal) 60 to 80 feet (18-24 M.) 
high, indigenous in India and Ceylon. 

Description and Properties. — Small, angular, dark brownish- 
red and transparent ; inodorous, very astringent and sweetish, 
coloring the saliva deep red. Soluble in alcohol, nearly insoluble 
in ether, and only slightly soluble in cold water. 

Dose. — 10-20 grains (0.6-1.2 Gm.). 

Official Preparation. 

Tinctura Kino — Tincturae Kino — Tincture of Kino. — Dose, ^2 fluidrachms 
(1.0-8.0 Cc). 

Physiological Action. — Its action is similar to that of tannic 
acid. It colors the saliva red. 

Therapeutics. — Externally and Locally. — Kino is an efficient 
dressing for flabby, indolent idcers, acting as a stimulant. Yet the 
other astringents deserve precedence. As a gargle in pharyngitis 
and relaxed uvula kino is valuable, but, owing to its disagreeable 



ASTRINGENTS. 719 

taste, krameria is to be preferred. Owing to its speedy action, it 
checks the hemorrhage in cpistaxis where other astringents fail. 
In leucorrhea d^nd gonorrhea an infusion or injection is serviceable. 

Internally. — In the polyuria of diabetes, in menoriliagia, the 
sweating of phthisis, and pyrosis it has been used to some advan- 
tage ; also in dysentery and chronic diarrheas with profuse serous 
discharges. It is less irritating than the other astringents. 

Administration. — The powder is used as an insufflation in 
epistaxis, and is dusted on ulcers. In diarrhea it is best to use kino 
in combination with opium or chalk mixture. The tincture is used 
internally. 

Krameria— Krameriae— Krameria. TI. S, J*. 

(Rhatany.j 

Orig-in. — The root of Krameria triandra Ruiz et Pavon, and of 
Krameria ixina L., a low shrub w^ith spreading branches, native to 
BoHvia and Peru, growing in sandy localities in the mountains at 
an altitude of 3000 to 8000 feet (900-2440 M.). 

Description and Properties. — From i to i^ inches (25-38 
Mm.) thick, knotty and several-headed above, branched below, the 
branches long ; bark smooth, or in the thinner pieces scaly, deep 
rust-brown, ^^ /^ ^^^^ (^"^ Mm.) thick, very astringent, inodor- 
ous ; wood pale, brownish-red, tough, with fine medullary rays, 
nearly tasteless. The root oi Krameria ixina (Savanilla rhatany) is 
less knotty and slenderer, and has a dark purplish-brown bark 
about \ inch (3 Mm.) thick. 

Dose. — 8-30 grains (0.5-2.0 Gm.). 

Official Pi'cparations. 

Extractum Krameriae— ExtrScti Krameriae— Extract of Krameria.— Z'^.f^, 
5-10 grains (0.3-0.6 Gm.). 

Extractum Krameriae Fluidum— ExtrScti Krameriae Fluidi— Fluid Extract 
of Krameria. — Dose, 5-30 minims (0.3-2.0 Co.). 

Tinctura Krameriae— Tincturae Krameriae— Tincture of Krameria.— Z)c?j^, 
\~2 drachms (2.0-8.0 Cc). 

Trochisci Krameriae— Trochiscos (ace.) Krameriae— Troches of Krameria. 
— Dose, I to 5 troches. (Each troche contains I grain (0.06 Gm.). 

Syrupus Krameriae — Syrupi Krameriae— Syrup of Krameria. — Dose, ^-4 
fluidrachms (2.0-16.0 Cc). 

Physiolog-ical Action. — The action of krameria is identical with 
that of tannic acid. 

Therapeutics. — Externally and Locally. — Its value as a topical 
appHcation is of little consequence, but it has served satisfactorily 



720 A TEXT-BOOK OF MA TERIA MEDICA. 

as an ointment for hemorrhoids. It is used as an infusion or injec- 
tion of the diluted tincture or fluid extract in leucorrhea, g^^^t, and 
especially in anal fissure, for which it has been highly recom- 
mended, since it checks the accumulation of feces in the rectum by 
constricting its walls, rendering defecation less painful and prevent- 
ing the formation of ulcers. The powder is used in epistaxis and 
rectal bleeding, also in prolapsus ani and ozena of a non-specific 
nature. It is used extensively in the preparation of tooth-powders, 
being especially beneficial where the gums display a tendency to 
bleed readily. A mouth-wash and gargle are used in ptyalism, 
spongy gums, pliaryngitis, and relaxation of the uvula. 

htternally. — Krameria has gained a wide reputation for allaying 
habitual, but not profuse, uterine hemorrhage. It may be used to 
check intestinal hemorrhages, hematuria, hematemesis, and hemopty- 
sis, but the other astringents are preferable. It is a good tonic for 
debilitated patients. It is also used in chronic diarrhea and dysen- 
tery and in incontineiice of urine. 

Administration. — The powder is used in the nose and rectum 
either by insufflation or by means of a pledget of cotton. As an 
injection and enema the fluid extract is used. In fissure of the 
anus the rectum must be emptied first by an enema ; then a solu- 
tion of the extract, i drachm (4.0 Gm.) to i ounce (30.0 Cc.) of 
water, is emptied into the bowel and allowed to run out, repeating 
the process several times. This procedure is very painful at first, 
but as the fissure gradually heals the operation will cause the 
patient little if any pain. Keep the bowels open with a mild 
saline laxative. The success attending the operation warrants any 
discomfort which the patient may experience. The nasal douche 
is best in ozena, followed by an insufflation of the powder. 

Haematoxylon— Haematoxyli— Haematoxylon. 

Z7. H. B. 

(Logwood.) 

Origin. — The heart-wood of Hoeniatoxylo7t Canipechianum L., a 
tree 30 to 40 feet (9-12 M.) high, indigenous on the shores of the 
Gulf of Campeachy and in certain parts of South America. 

Description and Properties. — Heavy, hard, externally pur- 
plish-black, internally brownish-red, marked with concentric cir- 
cles, splitting irregularly ; odor faint, agreeable, taste sweetish, 
astringent. When chewed it colors the saliva dark pink. 

Only the preparations of Haematoxylon are used internally. 



ASTRINGENTS. 721 

Official Preparatiojt. 

Extractum HaematSxyli — Extract! HaematSxyli — Extract of Haematoxy- 
lon. — Dose, 5-15 grains (0.3-1.0 Gm.). 

Physiological Action. — Its astringent properties are due to the 
tannin which haematoxylon contains. 

Therapeutics. — Externally and Locally. — It is a valuable anti- 
septic, as well as a healing application in gangrene and foul- 
smelling sores. It is also beneficial as an injection in leucon^hea. 

Internally. — Haematoxylon has a very agreeable, sweetish taste ; 
hence it is well taken by children. It is of marked benefit in in- 
fantile diarrhea, but has the disadvantage of coloring the dis- 
charges and diaper blood-red, causing much alarm to the mother. 
The urine is also colored. It arrests internal hemorrhage and 
sweating, and is also used in dysentery, tuberculous diarrhea, and 
atonic dyspepsia. Some authorities claim that haematoxylon causes 
phlebites. 

Administration. — In diarrhea a decoction with a little aromatic 
sulphuric acid is the best preparation. To it may be added a little 
syrup of ginger and camphorated tincture of opium. The decoc- 
tion is, in fact, the best preparation to use. 

Hamamelis— Hamamelidis— Hamamelis. TJ. S. I*. 

(Witch-hazel.) 

Origin. — The leaves of Hamamelis Virginica L., a shrub 6 to 
10 feet (1.8-3.0 M.) high, growing in damp woods and thickets in 
Canada and the United States. 

Description and Properties. — Short-petiolate, about 4 inches 
(10 Cm.) long, obovate or oval, slightly heart-shaped and oblique 
at the base, sinuate-toothed, thickish, nearly smooth, inodorous; 
taste astringent and bitter. 

Official Preparation. 
ExtrSctum HamamSlidis Fluidum— Extract! HamamSlidis Fluidi— Fluid 
Extract of Hamamelis. — Dose, >^-2 fluidrachms (2.0-8.0 Cc). 

Physiological Action. — The action of tannic acid is also that 
of hamamelis, save that the latter has a somewhat different influ- 
ence upon the circulation. 

Circulatory System. — Hamamelis acts on the muscular fibers of 
the veins, the modus operandi, however, not being satisfactorily 
determined. Large doses produce severe throbbing headache. 

46 



']22 A TEXT-BOOK OF MATERIA MEDICA. 

Therapeutics. — Externally a?id Locally. — For sprains and bruises 
hamamelis is a favorite application, although some authorities re- 
gard it merely as a placebo. Locally, the fluid extract, with the 
addition of one-third its volume of glycerin, has been used in 
urticaria, rhus-poisoning, and phlegmasia dolens. Owing to its 
marked sedative properties, hamamelis ointment is extremely 
beneficial in varicose ulcers, eczema, herpes, seborrhea, and acne 
rosacea, as well as in checking excessive secretions. It is also 
efficient in carbuncle, freckles, hyperidrosis, lupus erythematosus, 
burns, and frost-bites. 

The local action of the drug is important. The distilled 
extract, diluted with alcohol or water, is applied to inflamed gums, 
the nasal mucous membrane after removal of polypi, and in pharyn- 
gitis as a spray. As a suppository or applied by means of a piece 
of cotton or wool soaked with the fluid extract, hamamelis affords 
a most grateful relief in bleeding piles, especially the internal vari- 
ety. In cystitis and hemorrhage from the bladder an injection of 
the diluted fluid extract or distilled extract is very valuable, 
besides being a most reliable topical application in capillary hemor- 
rhage from wounds, epistaxis, and bleeding after extraction of teeth. 
The OINTMENT is used in rectal fissures and ulcers, and the lotion 
has been employed to some extent in chronic rheumatism, since 
it relieves the pain and stiffness in the muscles and joints. The 
decoction, with a little boric acid and a i per cent, solution of 
creasote, has been recommended as a gonorrheal injection. 

Internally. — Given internally, hamamelis enhances the results 
obtained by the local application in bleeding piles, leucorrhea, and 
gonorrhea, and, owing to its peculiar action upon the veins, in 
varicose veins. It lessens the pain of dysmenorrhea, while by its 
use in menorrhagia the flow is remarkably diminished. It is highly 
beneficial in i7iternal hemorrhages, hemoptysis, hematuria, hemateme- 
sis, and especially in uterine hemorrhages. It reduces suppuration 
in pyelitis and the excessive morbid discharge in chronic bronchitis. 
It is a valuable remedy in purpura hcemorrhagica, chronic eiiteritis, 
diarrhea, dysejitery, and varicocele. Hamamelis also prevents 
abortion. 

Administration. — The best preparation, both for internal and 
external use, is the distilled extract, although it is not official. The 
ointment and lotion are used externally, and the fluid extract 
internally. The preparations of hamamelis to be found in drug- 
stores are unreliable unless they be perfectly fresh. Some of the 



ASTRINGENTS. 723 

proprietary preparations are concocted with extreme care and 
accuracy, and are often much more efficient than the official 
articles which have been standing in the shops for a long while, 
possibly exposed to the air. 

Geranium— Geranii— Geranium. TJ, S. B. 

(Cranesbill.) 

Orig-in. — The rhizome of Geranium maculatum L., a perennial 
herb with a stem 2 to 3 feet (30-60 Cm.) high, very common in 
Canada and the United States westward as far as Kansas. 

Description and Properties. — Growth horizontal, cylindrical, 
2 to 3 inches (5-7 Cm.) long and about \ inch (i Cm.) thick; 
rather sharply tuberculated, longitudinally wrinkled, dark brown ; 
bark thin ; wood-wedges yellowish, small, forming a circle near the 
cambium line; medullary rays broad, central pith large; roots 
thin, fragile, inodorous ; taste strongly astringent. 

Dose. — 20-40 grains (1.2-240 Gm.). 

Official Preparation. 

Extractum Geranii Fluidum — Extr^cti Geranii Fluidi — Fluid Extract of 
Geranium. — Dose, 20-40 minims (1.2-2.40 Cc). 

Physiological Action. — The action of geranium corresponds 
with that of tannic acid. 

Therapeutics. — Externally and Locally. — Geranium is not used 
externally. Its local action is varied. It is serviceable as an 
astringent gargle in sore throat ; as a mouth-wash in aphthous 
stomatitis ; in relaxed conditions of the rectum, vagina, and throat ; 
in buccal idcer, metrorrhagia, and anal fisstire ; in prolapsus ani and 
epistaxis. It has also proved valuable as an injection in leucorrhea, 
gonorrhea, and gleet. 

Internally. — Owing to its agreeable taste, it is useful in infantile 
diarrhea and for persons having weak stomachs. In the early 
stages of phthisis it is very beneficial, as it reduces the fever and 
pulse-rate, at the same time checking the nig J it- sweats, cough, 
expectoration, and hemoptysis. Under it the patient's appetite im- 
proves and he gains in weight. The fluid extract, in combination 
with an aromatic, gives perceptible temporary relief in rapid acnte 
phthisis attended with severe, distressing cough and debilitating 
night-sweats. It has also been used to advantage in i7iternal 
hemorrhages. 



724 A TEXT-BOOK OF MATERIA MEDICA. 

Adrainistration. — Locally, the powdered root and fluid extracts 
are used, but the fluid extract diluted with water is preferable. 
For an injection a decoction, i ounce (32.0 Gm.) to 1-2 pints 
(512.0-1024.0 Gm.) of water, is used, and the decoction in milk 
is of service in infantile diarrhea. Prof Johnson claims that gera- 
nium contains mucilaginous material which, acting as a demulcent, 
makes the decoction a much more desirable preparation than a 
simple solution of tannin. 

Rhus Glabra— Rhais Glabrae— Rhus Glabra. TI. S. JP. 

(Sumach.) 

Origin. — The fruit of R/ms glabra L., a shrub or suffruticose 
plant about 12 feet (3.6 M.) high, growing in rocky or barren soil 
in North America. 

Description and Properties. — Subglobular, about \ inch (3 
Mm.) in diameter, drupaceous, crimson, densely hairy, containing 
a roundish-oblong, smooth putamen ; inodorous ; taste acidulous. 

Dose. — The preparations only are used internally. 

Official Preparation. 

Extractum Rhois Glabrae Fluidum — ExtrScti Rhois Glabrae Fluidi — Fluid 
Extract of Rhus Glabra. — Dose, \-\ fluidrachm (1.0-4.C Cc). 

Allied Species. 
Rhtis Aromatica — Rhois Aromaticae — Sweet Sumach. 

Unofficial Preparation. 

Extractum Rhois Aromaticae Fluidum — ExtrScti Rhois Aromaticae Fliaidi 
—Fluid Extract of Rhus Aromatica. — Dose, 5 minims- 1 fluidrachm (0.3-4.0 Co.). 

Physiological Action. — The action of Rhus glabra resembles 
that of tannic acid. 

Therapeutics. — Externally and Locally. — An infusion or the 
FLUID EXTRACT is uscd as a topical application for idcers and in- 
flamed wounds. The infusion is an excellent mouth-wash in 
spongy glims, ptyalism, pharyngitis, aphthous stomatitis, and tonsil- 
litis. It can be used alone, but is much more efficient when com- 
bined with potassium chlorate and glycerin, adding a little menthol, 
2-3 grains (.12-20 Gm.), to make the mixture more agreeable. It 
is also of service as an injection in leticorrhea. 

Internally. — Rhus glabra acts well in staying incontinence of 
urine and hematuria. A dose of 10-30 drops of the fluid extract^ 



ASTRINGENTS. 725 

taken two or three times daily, has produced complete temporary 
suspension of nocturnal enenrcsis of children, as well as senile 
eneiiresis. 

Administration. — The fluid extract is used exclusively. 

Rosa Gallica— Rosae Gallicae— Red Rose. TJ. S. I*. 

Orig-in. — The petals of Rosa gallica L., collected before ex- 
panding. 

Description and Properties. — Usually occurring in small cones 
consisting of numerous imbricated, roundish, retuse, deep purple- 
colored, yellow-clawed petals, having a roseate odor and a bitterish, 
slightly acidulous, and distinctly astringent taste. 

Official Preparations. 

ConfSctio Rosae — Confectionis Rosae — Confection of Rose. — Used as an 
excipient in pill masses, 

Extr^ctum Rosae Fluidum — Extract! Rosae Fluidi — Fluid Extract of Rose. 

— Used chiefly as a vehicle. 

Physiological Action. — It acts like tannic acid. 

Therapeutics. — Externally and Locally. — The ointment is used 
for chapped lips and hands, and also for superficial burns and in 
erythema. 

The FLUID EXTRACT is uscd as an application to inflamed eyes, 
buccal, aural, and anal idcers, and in aphthous stomatitis. It has 
been employed in conjunction with sodium salicylate to prevent 
the pitting of small-pox. Its chief use, however, is as a vehicle 
and flavoring extract. 

Internally. — It is practically of but little value as an internal 
agent, although it exerts some action in checking profuse sweats 
and in uterine hemorrhages. 

Administration. — The fluid extract is mainly used, an infusion 
of which is given internally. The fresh leaves, crushed, are ser- 
viceable as a poultice. 

Rubus—Rubi— Blackberry. TJ, S. JP. 

Origin. — The root-bark of Rubtis villosus Ait., Rubus Canaden- 
sis L., and Rubus trivialis Mx., common shrubby North American 
plants. 

Description and Properties. — Thin, tough, flexible bands, outer 
surface blackish or blackish-gray, inner surface pale-brownish, some- 



726 A TEXT-BOOK OF MA TERIA MEDICA. 

times with strips of whitish, tasteless wood adhering ; inodorous ; 
taste strongly astringent, somewhat bitter. 

Official Preparation. 

Extractum Rubi Fluidum— Extract! Rubi Fluidi— Fluid Extract of Rubus. 

— Dose, \-2 fluidrachms (2.0-8.0 Cc). 

Physiological Action. — Identical with that of tannic acid. 

Therapeutics. — Internally. — The fluid extract is used in the 
summer diarrhea of children — practically its only employment. An 
infusion of the leaves is claimed by Popoff to be an excellent 
remedy for debility of the bladder. 

Administration. — The fluid extract and the infusion are used 
as medicinal agents. The syrupus rubi idsei is used only as a 
vehicle. Blackberry cordial and blackberry brandy are favorite 
modes of administration. It is commonly believed by the laity 
that the various blackberry and raspberry preserves are efficacious 
as remedies ; on the contrary, they are highly irritating, because of 
the seeds present in them. 

MINERAL ASTRINGENTS. 

Plumbum— Plumbi— Lead. 

The salts of lead only are used in medicine. 

Plumbi Acetas— Plumbi Acetatis— Lead Acetate. 

V. S. jP. 

(Sugar of Lead.) 

Origin. — Metallic Lead is dissolved, in the presence of air, in 
Acetic Acid, or Lead Oxide is dissolved by the aid of a gentle heat 
in Acetic Acid and Water, the solution being filtered, evaporated, 
and crystallized. 

Description and Properties. — Colorless, shining, transparent, 
monoclinic prisms or plates, or heavy, white, crystalline masses, or 
granular crystals, having a faintly acetous odor and a sweetish, 
astringent, and afterward metallic taste. On exposure to the air 
efflorescent and absorbing carbon dioxide. ' Soluble in 203 parts 
of water and in 21 parts of alcohol, in 0.5 part of boiling water, 
and in i part of boiling alcohol. Lead acetate should be kept in 
well-stoppered bottles. 

Dose. — ^5 grains (0.03-0.3 Gm.). 



ASTRINGENTS. 727 

Official Preparations. 

Liquor Pltimbi Subacetatis— Liquoris Pltimbi Subacetatis— Solution of 
Lead Subacetate (Goulard's Extract).— Used externally and locally. (The solu- 
tion contains about 25 per cent, of Lead Subacetate.) 

Liquor Pltimbi Subacetatis Dilutus— Liquoris Pltimbi Subacetatis Diluti 
— Diluted Solution of Lead Subacetate (Lead Water).— Used externally and 
locally. (It contains 3 per cent, of Lead Subacetate.) 

Ceratum Pltimbi Subacetatis— Cerati Pltimbi Subacetatis— Cerate of Lead 
Subacetate (Goulard's Cerate).— Used externally and locally. (Goulard's Extract, 
20; Camphor Cerate, 80 parts.) 

Unofficial Preparation. 

LinimSntum Pltimbi Subacetatis — LinimSnti Pltimbi Subacetatis — Lini- 
ment of Lead Subacetate. — Used externally and locally. (40 parts of Lead Sub- 
acetate to 60 parts of Cotton Seed Oil.) 

Plumbi Carb5nas— Plumbi Carbonatis— Lead Car- 
bonate. U.S. I". 

(White Lead.) 

Origin. — Obtained by passing Carbon-dioxide Gas through a 
solution of Lead Acetate, or by adding an Alkali Carbonate to 
a solution of a Neutral Lead Salt. 

Description and Properties. — A heavy, white, opaque powder 
or a pulverulent mass, without odor or taste. Permanent in the 
air. Insoluble in water or alcohol, but soluble in acetic or diluted 
acetic acid, with effervescence. Lead carbonate should be kept in 
well-stoppered bottles. Used externally and locally. 

Official Preparation. 

UnguSntum Pltimbi Carbonatis — UnguSnti Pltimbi Carbonatis — Ointment 
of Lead Carbonate (10 per cent.). — Used externally and locally. 

Plumbi lodidum— Plumbi I5didi— Lead Iodide. 

V. S. I". 

Origin. — Obtained by mixing a solution of Lead Nitrate and 
Potassium Iodide, and drying the precipitate. 

Description and Properties. — A heavy, bright-yellow powder 
without odor or taste. Permanent in the air. Soluble in about 
2000 parts of water and in about 200 parts of boiling water, sep- 
arating from the latter solution in brilliant golden-yellow spangles 
or crystalline laminae. Very slightly soluble in alcohol, but sol- 
uble, without color, in solutions of the fixed alkalies, in concen- 



728 A TEXT-BOOK OF MATERIA MEDIC A. 

trated solutions of the acetates, of the alkalies, potassium iodide, 
and sodium hyposulphite, and in a hot solution of ammonium 
chloride. Lead iodide should be kept in well-stoppered bottles. 
Dose. — \ grain (0.13 Gm.). 

Official Preparation. 

UnguSntum Pltimbi lodidi — UnguSnti Pltimbi lodidi — Ointment of Lead 
Iodide (10 per cent.), — Used externally and locally. 

Plumbi NItras— Plumbi Nitratis— Lead Nitrate. 

Z7. H. r. 

Orig-in. — Prepared by dissolving Lead in Diluted Nitric Acid. 

Description and Properties. — Colorless, transparent, octahedral 
crystals, or white, nearly opaque crystals, without odor and having 
a sweetish, astringent, and afterward metallic taste. Permanent in 
the air. Soluble in 2 parts of water ; almost insoluble in alcohol. 
Used externally and locally. 

Plumbi Oxidum— Plumbi Oxidi— Lead Oxide. 

U. S. JP. 

(Litharge.) 

Origin. — Obtained by roasting Lead in air. 

Description and Properties. — A heavy, yellowish or reddish- 
yellow powder or minute scales, without odor or taste. On expo- 
sure to the air it slowly absorbs moisture and carbon dioxide. 
Almost insoluble in water and insoluble in alcohol. Soluble in 
acetic or diluted nitric acid and in warm solutions of the fixed 
alkalies. Lead oxide should be kept in well-closed vessels. Used 
externally and locally. 

Official Preparations. 

Empiastrum Pltimbi — Empiastra Pltimbi — Lead Plaster (Diachylon Plas- 
ter). — Used externally and locally. 

(Lead Oxide or Lead Plaster is contained in Emplastrum Ammoniaci cum Hydrar- 
gyro and in Emplastra Ferri, Hydrargyri, Opii, Resinae, and Saponis.) 

Ungufentum Diachylon — UnguSnti Diachylon— Diachylon Ointment. — 
(Lead Plaster, 500; Olive Oil, 490; Oil of Lavender Flowers, 10.) Used externally 
and locally. 

Physiolog'ical Action. — Lead per se is practically inert ; some 
of its salts, however, particularly the acetate, possess valuable 
therapeutic properties. 



ASTRINGENTS. 729 

Externally and Locally. — Applied to the unbroken skin, lead 
salts have little if any effect, yet they act readily upon denuded 
surfaces, blanching the tissue of the parts by contraction of the 
small blood-vessels. In sores and ulcers they coagulate the 
albumin of the discharge and the protoplasm of the neighboring 
superficial cells, thus forming a protective coating for the healthier 
structure beneath. 

These salts have Hkewise a sedative action because of the 
decreased local circulation and the presumably depressant effect 
upon the nerve endings. Moreover, by virtue of their astringency 
they furnish valuable hemostatic and antiphlogistic remedies. In 
some cases the skin is discolored by their use. 

Internally. — Digestive System. — Lead acts immediately in the 
mouth, causing a sweet, styptic taste and coagulating the mucus. 
It contracts the cells and vessels of the entire alimentar).^ canal, 
inducing dryness by diminished secretion. Consequent to the dis- 
turbed physiological functions of the digestive tract, the peristaltic 
movements diminish, and constipation necessarily ensues. 

Circulatory System. — The heart's action is slowed through the 
branches of the vagus by irritation of the cardiac inhibitory center. 
The pulse is lessened in volume and frequency, and lacks regularity. 

The blood takes up the lead as an albuminate, which soon 
passes into the tissues. While yet in the vascular system it inter- 
feres with the nutritive function of the corpuscles, producing by 
their destruction a watery condition of the blood. This explains 
the anemia usually present in cases of plumbism or lead-poisoning. 

Nervous System. — Both sensory and motor functions become 
deranged, especially the latter. This central irritation causes a dis- 
turbance, and finally paralysis, of various muscles. The involun- 
tary muscles appear to be most affected, and of these primarily the 
intestinal ; hence, with the assistant local effect, arise distressing 
abdominal pains and spasms. The cardiac center and vagal 
branches to the heart are influenced, as already stated. 

Respiratory System. — The irritation produced in the respiratory 
centre has an inhibitory action through the vagus upon the respira- 
tion. 

Absorption and Elimination. — The preparations of lead are con- 
verted in the stomach into an albuminate, and thence taken up by 
the blood, very little absorption taking place in the intestine, where 
the lead is converted into an insoluble sulphide. It is absorbed by 
the abraded skin, and enters directly into combination with the 



'J2>0 A TEXT-BOOK OF MATERIA MEDICA. 

albumin of the tissues. A portion of the lead albuminate is elimi- 
nated by the liver with the bile into the intestine, where, being con- 
verted into a sulphide, it is excreted in that form with the feces. 
The skin, kidneys, and mammary glands assist in its elimination. 

Lead is not easily removed from the whole system, owing to its 
retention by the ubiquitous albumin ; consequently some alterative^ 
such as potassium iodide, should be administered. 

Uterus. — Under the influence of lead, abortion is liable to occur 
or the child be still-born. This is probably due to a disturbance 
of the quality and quantity of the blood-supply to the affected 
parts. 

Untoward Action. — Undesirable results have followed the ad- 
ministration of medicinal doses of lead acetate, evidently arising 
from insufficient elimination. Baker observed loss of appetite, gas- 
tralgia, constipation, and paralysis of three weeks' duration. This 
last symptom occurred in the hand of a man who had taken i grain 
(.06 Gm.) of lead acetate twice daily for four days to relieve hema- 
turia. In another case attacks of colic, lasting several months, fol- 
lowed the exhibition of 4 grains (.25 Gm.) of the same salt for 
three days. Tanquere des Planches suggests caution in too free 
an administration of lead preparations, as being prone to occasion 
disagreeable symptoms. 

The external application of lead solutions and ointments some- 
times produces unpleasant effects, such as discoloration of the skin. 
In the mucous membrane lead rarely excites symptoms of poison- 
ing, a single case being reported where lead water compresses 
were applied to the eye. Gastric pains have occurred after re- 
peated applications of such compresses to a contused shoulder, the 
pains ceasing with their withdrawal and reappearing with a renewal 
of the treatment. Colic and paralysis of the member have fol- 
lowed washing of a large ulcer of the leg with lead water, these 
symptoms disappearing upon a withdrawal of the drug. In still 
another case a sweetish, styptic taste in the mouth and stiffness of 
the neck resulted from the external use of the solution. 

Poisoning. — Cases of acute poisoning are in therapeutics for- 
tunately rare, the acetate — the form generally given — producing 
emesis, thus preventing toxic effects of the drug. 

The first symptom of poisoning is a sweetish, metallic taste, 
soon followed by nausea and vomiting of a white, milky fluid con- 
taining curdy material — the result of a combination of the exces- 
sive lead with the hydrochloric acid of the gastric juice, and the 



ASTRINGENTS. 731 

formation of lead chloride. Constipation and subsequent diarrhea 
usually occur, with black passages, the discoloration being caused 
by the sulphide of lead formed in the intestinal canal. There is 
severe, persistent pain in the abdominal muscles, which are rigid 
and contracted, while a retraction of the abdominal walls is clearly 
perceptible. There are great thirst, and possibly cramps in the 
calves of the legs, neuralgic pains, muscular twitchings, vertigo, 
stupor, anesthesia, and paralysis. Tenesmus is present, and the 
face is pale and the lips Hvid. A blue Hne, due to a deposit of the 
sulphide, is usually found on the gums near the incisor teeth. As 
a rule, the liver is retracted and often diminished in size. The pulse 
is rapid and tense at first, becoming weak, compressible, and slow. 

Ti^eatment of Poisoning. — Evacuation of the stomach is impera- 
tive, the process being more or less assisted by the emetic property 
of the drug. Some sulphate should be administered in order to 
form an insoluble lead compound. Epsom and Glauber's salts are 
the best antidotes, since they are readily soluble and easily ob- 
tained ; acting, moreover, as a purge, they empty the intestinal 
canal. Opium wAW serve to relieve pain and irritation, while to 
maintain bodily temperature hot applications can be used on the 
feet and abdomen. 

Chronic Poisoning. — The acute form of poisoning just considered 
is always produced by a soluble lead salt ; chronic plumbism, on 
the contrary, is invariably caused by an insoluble salt. The symp- 
toms are numerous and manifold, there being no physiological dis- 
turbance of the acute which is not present in the chronic condition. 
The train of untoward symptoms is occasioned by long-continued 
medicinal use of lead preparations. Very frequent sources of 
poisoning are : drinking water conveyed in lead pipes, and foods 
colored with chrome yellow and those contained in cans soldered 
with lead. It is especially liable to occur among painters (colica 
pictonum), manufacturers of lead salts, color-grinders, and type- 
setters and founders. 

Wrist-drop, bilateral, resulting from paralysis of the extensor 
muscles of the forearm, is one of the most prominent symptoms, 
although not a constant occurrence. The supinator longus, being 
also a flexor, usually escapes this influence. Colic, sharp abdom- 
inal pains, chiefly in the umbiHcal region, retraction of the abdom- 
inal muscles and cramps, and paralysis of the calves of the legs 
may be present in plumbism — or " saturnism," as it is sometimes 
termed, a word transmitted to us from medieval alchemy. Obsti- 



732 A TEXT-BOOK OF MATERIA MEDICA. 

nate constipation, with the passage of clay-colored stools, as has 
been stated, necessarily occurs ; and anorexia, gastralgia, and 
arthralgia are seldom absent. The liver, the most important me- 
dium in the elimination of the poison, in severe cases becomes 
overtaxed and reduced in size. The tongue is white and coated, 
and the skin, lips, and mucous membranes are discolored. A blue 
line on the anterior gums is pathognomonic, although it may be 
absent in those who take special care of the teeth. 

Headache, delirium, and epileptiform convulsions, constituting 
encephalopathia saturnina, may occur, being usually due to uremia 
induced by insufficient ehmination of the poison. Albuminuria, 
cirrhosis, and contraction of the kidneys, with diminished excretion 
of uric acid, are present, and amblyopia and amaurosis may be in- 
cluded among the symptoms. The heart and the entire vascular 
system are, as has been said, considerably deranged. Multiple 
neuritis, anterior poliomyehtis, and atrophy of the nerve-trunks, 
with resultant muscular wasting and loss of power, gradually mani- 
fest themselves. Gout sometimes occurs, and, as noted in acute 
poisoning, miscarriage is liable to take place. 

Treatment of Poiso7iing. — The sulphates are given for their 
chemical and purgative effects, yet in chronic plumbism the hepatic 
purgatives — calomel, gamboge, jalap, etc. — are preferable. Opium 
and morphine relieve pain and spasms, being claimed by some 
authorities as specifics in lead-poisoning. Sulphuric-acid lemonade 
and plenty of milk have been found beneficial. Potassium iodide 
in ten-grain doses, three times daily, has an eliminative effect. The 
cerebral symptoms may be alleviated by a diaphoretic, such as 
pilocarpin or an alcohol sweat. 

In progressive paralysis strychnine is widely employed. Fara- 
dization of the muscles, if they respond, or otherwise galvanization, 
should be used to increase muscular force and prevent atrophy. 

Plumbi Acetatis. — This being the typical lead salt, its action 
will be first considered. 

Therapeutics. — Externally aiid Locally. — It acts as a sedative 
as well as an astringent in acute inflammations, such as eczema (not 
chronic), impetigo, lichen, and erythema ; but it must not be used 
stronger than lo grains (0.64 Gm.) to i ounce (30.0 Cc.) of water. 

It is of service as an injection in gonorrhea, leucorrhea, gleet, 
and otorrhea. In combination with opium it makes a good topical 
application for hemorrhoids. As a gargle it is of some value, and 
is also serviceable in orchitis, synovitis, and paronychia. 



ASTRINGENTS. yi)^ 

Internally. — Its most important use is in checktJig hemorrhages, 
in which it is associated with opium, although it is chemically in- 
compatible with that drug. It is of service in hemorrhage in typhoid 
fever, yellow fever, hemoptysis, and gastric ulcer. It lowers the 
heart's action, constringing the arterioles, in this respect resembling 
digitalis, combined with which drug it is beneficial in hypei'tropJiy 
of the heart. 

Morbid discharges, such as the night-siveats and diarrhea of phthi- 
sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions 
in bronchorrJiea, and serous diai^rhea, are effectually checked by the 
acetate of lead and opium, which diminishes the pain, griping, and 
tenesmus attending the respective affections. By far its most fre- 
quent use, however, is in serous diarrheas, the drug acting very 
quickly and efficiently, and being both sedative and astringent. 

Given in chronic gastritis with pain, lead acetate affords marked 
relief It was at one time advocated in internal aneiirysm, but is 
of little if any value in this respect. 

Liquor Plumbi Subacetatis. — This preparation is used exten- 
sively for bruises, sprains, acute eczema, and as a cooling application 
in ecthyma, erysipelas, and all kinds of inflammations ; it should 
be well diluted. It also relieves, the itching of urticaria, pruritus 
pudendi, and eczema. 

A felon may be aborted by saturating bread-crumbs with 
Goulard's solution, making a poultice, and placing it over the finger. 

Plumbi Iodidi. — Used very little. It acts beneficially when 
employed as an ointment applied to enlarged lymphatic glands and 
spleen ; also for psoriasis and chronic eczema. 

It is given in 1-2 grain- (0.06-0.12 Gm.) doses to reduce malarial 
spleen. 

Carbonate of lead is used only externally, in the form of an 
ointment, for burns, scalds, erysipelas, and intertrigo. It should 
never be applied to abraded surfaces, as it is rapidly absorbed. It 
should be mixed with linseed oil. 

Plumbi Oxidum. — Hebryre commends an application of equal 
parts of lead plaster and Hnseed oil for sweating of the feet. It is 
chiefly used in the preparation of diachylon or lead-plaster, emplas- 
trum saponis and emplastrum resinse being also prepared with the 
oxide. 

Plumbi Nitras. — Used with good results in onychia and also 
in the manufacture of Ledoyne's disinfectant. It is an excellent 
remedy for fissured nipples, care being taken to wash the nipple 



734 ^ TEXT-BOOK OF MATERIA MEDICA. 

before suckling. Should the fissures be deep, it is well to wash 
the nipple with morphine sulphate or a little cocaine, as the lead 
application is exceedingly painful. 

It destroys the fetid odor arising from gangrenous sores and 
offensive discharges from the ears, nostrils, rectum, and vagina. 
It has also proved serviceable in epithelioma. 

Chloride of lead and tannate of lead have been used ex- 
ternally as ointments — the chloride to ^W^d^y pain and arrest morbid 
grozvths, and the tannate in threatening bed-sores. 

Adniinistration. — Locally a watery solution of lead acetate, lo 
grains (0.64 Gm.) to i ounce (30.0 Cc), is used. Powdered opium 
can be added, i drachm to the pint of water. Applied to mucous 
membranes or used as an injection, 2 grains (0.12 Gm.) to i ounce 
(30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 (0.32 
Gm.) of zinc sulphate in i ounce (30.0 Cc.) of water — rose-water, 
for instance — proves a most efficient application. Suppositories for 
hemorrhoids may contain i grain (0.06 Gm.) of opium to 3-5 grains 
(0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio — lead 
acetate 3 grains (0.19 Gm.), opium i grain (0.06 Gm.) — is mostly used 
internally, one pill being taken every three hours. In dysentery and 
cholera infantum an enema containing 5 grains (0.32 Gm.) of lead 
acetate to i grain (0.06 Gm.) of opium, or J grain (0.03 Gm.) of 
morphine to i ounce (30.0 Cc.) of water, gives excellent results. 

Should there be any abrasion of the skin, lead subacetate must 
not be used, as it prevents healing by constringing the edges of 
the wound. 

It is not used internally. 

Solution of subacetate of lead is most frequently used in union 
with opium, forming the well-known L. and L., or lead-water-and- 
laudanum, solution. It is also used in conjunction with glycerin, 
I ounce of each, or as Goulard's cerate, consisting of 20 parts 
Goulard's extract to 80 parts camphor cerate. 

For ulcers, fissured nipples, and epithelioma lead nitrate is used, 
chiefly in the powdered form. In the nose, ears, vagina, and rectum 
a douche (2-5 grains (0.13-0.32 Gm.) to i ounce (30.0 Cc.) of water) 
is used. A solution of 10 grains (0.64 Gm.) to i ounce (30.0 Cc.) 
of glycerin or brandy is a very good application for sore nipples. 

ZTncum— Zinci— Zinc. U, S. B. 

Origin. — Obtained by roasting the native Zinc Sulphide or Car- 
bonate, and reducing the resulting oxide with charcoal. 



ASTRINGENTS. 735 

Description and Properties. — A bluish-white metal, showing 
a crystalline fracture and having a specific gravity ranging from 6.9 
when it is cast to 7.2 after it is rolled. Soluble in diluted sulphuric 
or hydrochloric acid, with evolution of hydrogen gas. 

Metallic zinc occurs in the form of thin sheets or in irregular, 
granulated pieces, or moulded into thin pencils, or in a state of 
fine powder. 

The following salts of zinc are official : 

Zinci Acetas — Zinci Acetatis — Zinc Acetate. — Origin. — Obtained by dissolv- 
ing Zinc Acetate in Acetic Acid and Water and boiling : zinc acetate crystallizes out. 

Description and Properties. — Soft, white, six-sided, monoclinic plates, of a pearly 
luster, having a faintly acetous odor and an astringent metallic taste. Exposed to the 
air, the salt gradually effloresces and loses some of its acid. Soluble in 2.7 parts of 
water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. 

Dose. — As a tonic, ^-2 grains (0.03-0.12 Gm.) ; as an emetic, 10-30 grains 
(0.6-2.0 Gm.) ; but principally used externally and locally. 

Zinci Carbonas Praecipitatus — Zinci Carbonatis Praecipitati — Precipitated 
Zinc Carbonate. — Origin. — Prepared by pouring together solutions of Zinc Sulphate 
and Sodium Carbonate, and drying the precipitated zinc salt. 

Description and Properties. — An impalpable white powder, of somewhat variable 
chemical composition, without odor or taste ; permanent in the air. Insoluble in water 
or alcohol. 

Dose. — 2-3 grains (0.12-0. 1 8 Gm.). Chiefly used externally. 

Zinci lodidum — Zinci lodidi — Zinc Iodide. — Origin. — Prepared by dissolving 
Zinc Oxide or Carbonate in Hydriodic Acid. 

Description and Properties. — A white, granular powder, odorless, having a sharp, 
saline, and metallic taste. Very deliquescent, and liable to absorb oxygen from the air, 
becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. 
Zinc iodide should be kept in small glass-stoppered bottles. 

Dose. — 1/2-2 grains (0.03-0.12 Gm.). Also used externally, 

Zinci Siilphas — Zinci Sulphatis — Zinc Sulphate. — Origin. — Prepared by dis- 
solving Granulated Zinc in Sulphuric Acid, certain precautions being taken to remove 
impurities. 

Description and Properties. — Colorless, transparent, rhombic crystals, without odor, 
and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part 
of water and in 3 parts of glycerin ; insoluble in alcohol. Zinc sulphate should be kept 
in well-stoppered bottles. 

Dose. — 1-3 grains (0.06-0.18 Gm.) ; as an emetic, 10-60 grains (0.6-4.0 Gm.). 

Zinci Oxidum — Zinci Oxidi — Zinc Oxide. — Origin. — Prepared by heating Zinc 
Carbonate to redness in a crucible. 

Description and Properties. — An amorphous white powder without odor or taste. 
Insoluble in water or alcohol. It should be kept in well-stoppered bottles. 

Dose. — ^-5 grains (0.015-0.3 Gm.). 

Official Preparations of Zinc Oxide. 
UnguSntum Zinci Oxidi— UnguSnti Zinci Oxidi — Ointment of Zinc Oxide 

(20 per cent.). — Used externally and locally. 

Antagonists and Incompatibles. — The salts of zinc are incom- 



11^ 



A TEXT-BOOK OF MATERIA MEDICA. 



patible with the vegetable astringents, alkaHes and their carbonates, 
lime water, the sulphides, silver nitrate, lead acetate, and milk. 

Synergists. — The same as for lead. 

The metalHc form is not used in medicine. 

Physiolog'ical Action. — Externally and Locally. — The zinc salts 
resemble the lead salts in their action, but they are less powerful 
astringents. They are also to a slight extent hemostatic. The 
chloride is exceedingly caustic. 

Internally. — Digestive System. — The sulphate of zinc and, in a 
sHght degree, the carbonate are specific emetics, causing rapid 
emesis, with but little nausea or depression. Their modus operandi 
is not definitely known, but it is beheved that their effects are 
partly due to local action on the stomach, and partly to stimulation 
of the vomiting center in the medulla. 

Vomiting is also produced by injecting a solution of the salt 
into the circulation ; but this is doubtless owing to the fact that 
the salt is excreted by the stomach, and that it also exerts an 
influence on the medullary center. 

The salts of zinc also act as astringents upon the gastro-intes- 
tinal mucous membrane. 

Circidatory System. — Practically nothing is known of the action 
of zinc salts on the heart, blood, and vessels. They exist in the 
blood as albuminates, in close relation with the red corpuscles. 

Nervous System. — Zinc valerianate acts as a sedative, but this 
action is wholly dependent upon the valerian. 

The salts are also astringents and possess some tonic properties. 
They may cause transverse myelitis. 

Absorption and Elinnnation. — The zinc salts are absorbed from 
the stomach or enter directly into the circulation when injected. 
They are eliminated by the liver and kidneys, but mainly by the 
intestinal glands. Zinc salts do not accumulate so rapidly as mer- 
cury, lead, and copper. 

Untoward Action. — 3-5 grains (0.19-0.32 Gm.) have produced 
nausea and gastric oppression, while if the zinc salt reaches the intes- 
tines diarrhea results. When taken on a full stomach the salts form an 
insoluble albuminate which undergoes the regular digestive process. 

Repeated small doses, 3 grains (0.19 Gm.), have produced gastric 
oppression, eructations, slight confusion of thought, dizziness, bodily 
exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc dyscra- 
sia may follow, characterized by obstinate constipation, emaciation^ 
and anemia. 



ASTRINGENTS. 737 

Poisoning. — Continued use or excessive dosos of zinc will pro- 
duce poisoning, with symptoms resembling those of lead-poisoning. 
Chronic zinc-poisoning is rare. 

Treatmoit of Poisoning. — Chemical antidotes are the bicarbon- 
ates of soda and potassium. Flour and water, soapsuds, and milk 
are also beneficial. Morphine given hypoder.mically relieves the 
vomiting. Laxatives and potassium iodide may serve later to 
assist in eliminating the zinc. 

Therapeutics. — ZI^x Oxide. — Externally and Locally. — The 
ointment or powder is used in chronic eczema, iiitertrigo, burns, fis- 
sured nipples, anal fissure, ulcers, and skin diseases. In combination 
with linseed oil the oxide has also been used in erysipelas. The 
drug has proved useful as an injection in leucorrhea. 

Internally. — Associated with bismuth, sodium bicarbonate, or 
belladonna, it is very effective in diarrhea — particularly the summer 
diarrhea of children — and dysentery. 

It is a most excellent remedy for colliquative sweating and the 
sweating of phthisis, and also serves to check the profuse secretion 
of bronchorrhea, although its use may occasion disordered diges- 
tion, since zinc is but sparingly soluble. 

It has been used extensively in the treatment of hysteria, spas- 
modic asthma, chorea, and epilepsy ; yet, even though it is claimed 
to be a specific, its action as such is exceedingly doubtful. 

Zinc oxide has proved highly beneficial in whooping cough, de- 
lirium tremens, and chronic alcoholism — especially the two latter, 
which are attended with considerable nervousness. 

The oxide is also valuable in gastralgia. 

7.1^0. Acetate. — It is used only externally and as an injection in 
gonorrhea and leucorrhea. In conjunctivitis it is useful as a collyrium. 

Zinc Sulphate. — Externally ajzd Locally. — The external use is 
chiefly in weeping eczema, pruritus, and ulcers. Locally it is of ser- 
vice as a wash in ophthalmia and conjunctivitis, and as an injection 
in gonorrhea, leucorrJiea, vulvitis, and otitis. It is also used in gan- 
grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils 
and relaxedv sore throat. In nasal polypi \h^ powder is insufflated, 
the solution being applied to the stump after removal of the poly- 
pus. It dries up soft tumors near the vagina, anus, and female 
urethra. It is also used in lupus exedens and cancer of tJic breast, 
but does not act upon parts covered by epithelium. Its application 
is very painful, but the eschar does not tend to spread, and sepa- 
rates much more readily than those of many other caustics. 
47 



738 A TEXT-BOOK OF MATERIA MEDICA. 

Internally. — Its chief use is that of an emetic after ingestion of 
poison, irritating foods, and especially narcotics, as well as where 
the air-passages are obstructed, as in croup and diphtheria. 

It acts as an astringent in chrojiic diarrhea and dysentery when 
associated with opium and ipecac. It is serviceable in typhoid fever, 
Jiatulent dyspepsia, coursing oxidaria, spasmodic asthma, and whoop- 
ing cough. Like the other zinc salts, it has also been used in 
hysteria, chorea, epilepsy, and angifia pectoris. 

Zinc Carbonate. — This preparation is used only externally, for 
blisters, weeping eczema, and intertrigo. It is employed in the form 
of a powder, but generally as an ointment — cardamine ointment. 

Zinc Iodide. — This salt is but little used, but is of some value 
as a gonorrheal injection, as an application to enlarged and indu- 
rated tonsils, and in scroftdous glands. 

Ta^z phosphide and zinc valerianate are used only for the 
benefit derived from the phosphorus and valerianic acid, and may 
properly be omitted here. 

Administration. — Externally the powder or ointment of zinc 
oxide is used, or the drug may be mixed with powdered starch, 
lycopodium, or acacia. Before applying these preparations it is 
well to wash the parts with a weak solution of carbohc acid. 

Internally, \ grain (o.oi Gm.) zinc oxide and 3 grains (0.19 Gm.) 
sodium bicarbonate are given in diarrhea, or, if preferable, bismuth 
subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), 
and zinc oxide ^-i grain (0.03-0.06 Gm.), with a little opium added. 

As an injection a combination of 10 grains (0.64 Gm.) each of zinc 
sulphate and lead acetate is used, the two salts interacting and pro- 
ducing lead sulphate — which is precipitated and insoluble — and zinc 
acetate. 

Locally and externally the dry powder of zinc sulphate is 
used, or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosse 

4 ounces (118.29 Cc), and glycerin i drachm (4.0 Cc), as a lotion. 
As an injection it is associated with lead acetate, forming the zinc 
acetate and lead sulphate. In oplithalmia neonator2im zinc sulphate 

5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and 
aqua rosae i ounce (30 Cc), perhaps with atropine added, form 
an excellent mixture. 

Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) may be given, 
and for intestinal affections i grain (0.06 Gm.) each of the sulphate, 
powdered opium, and ipecac three times daily. To produce emesis 
5 grains (0.32 Gm.) are sufficient. 



ASTRINGENTS. 739 

The collyrium consists of J grain (0.03 Gm.) of the salt in i 
ounce (30 Cc.) of rose water. 

Cupri Sulphas— Cupri Sulphatis— Copper Sulphate. 

U. S. JP. 

Origin. — Prepared by heating Copper and Sulphuric Acid to- 
gether, dissolving the soluble product in hot Water, and evaporating. 

Description and Properties. — Large, transparent, deep blue 
triclinic crystals, odorless, of a nauseous, metallic taste ; slowly 
efflorescent in dry air. Soluble in about 2.6 parts of water and in 
0.5 part of boiling water; almost insoluble in alcohol. 

Dose. — |— J- grain (0.008-0.03 Gm.), as an astringent; as an 
emetic, 2-20 grains (0.12-1.2 Gm.). 

Antagonists and Incompatibles. — Alkalies and their carbon- 
ates, the sulphides, mineral salts (except the sulphates), lime water, 
the iodides, and vegetable astringents. 

Synergists. — The same as for lead. 

Physiological Action. — Copper sulphate is the salt mostly 
used, and the only official preparation. Its action is therefore given 
as characteristic of that of cuprum. 

Externally. — Applied to the unbroken skin, it produces little 
effect, but on raw surfaces or mucous membranes it acts as a pain- 
ful caustic and astringent. It also possesses antiseptic properties. 

Internally. — Digestive System. — It acts as an irritant, causing 
vomiting of greenish matter, though nausea does not follow the 
emesis. The secretions are augmented, and salivation and purging 
of blood and mucus are attendant consequences of its ingestion. 
Should emesis be delayed, the stomach should immediately be 
emptied, otherwise the copper is liable to produce inflammation. 

Circnlatory System. — Copper exists normally in the blood, and 
acts as a tonic, being present in the circulation as an albuminate. 
It depresses the heart's action, causing a small, weak, rapid pulse. 

Nervous System. — It acts as a depressant. 

Respiratory System. — Its influence is to hasten and depress the 
respiratory movements. 

Absorption and Elimination. — Copper salts are slowly absorbed, 
tending to accumulate in the liver. The drug is eliminated by the 
liver, kidneys, salivary glands, and intestinal canal. 

Poisoning. — Acute poisoning results from the inhalation of 
cupreous fumes, eating fruits cooked in copper vessels, or from 
an overdose of a copper salt. 



740 A TEXT-BOOK OF MATERIA MEDIC A. 

When inhaled the first symptoms are those of bronchial catarrh 
and irritation. Internally administered, the symptoms do not usually 
appear at once, but after an hour's interval there are manifest a 
strong metallic taste in the mouth, burning and constriction of the 
pharynx and fauces, salivation and vomiting of greenish matter, and 
purging, the passages after a while containing mucus streaked with 
blood. There are present also burning in the epigastrium and 
griping, colicky pains. 

Copper enters the circulation quickly, it being highly diffusible. 
A characteristic symptom of poisoning is a green line on the gums. 
Sometimes jaundice may be present, and headache, convulsions^ 
suppression of urine, cardiac depression, and hurried respiration are 
among the graver symptoms. 

Tj^eatment of Poisoning. — A chemical antidote should be given 
at once, potassium ferrocyanide being the best, as it forms an in- 
soluble copper cyanide. Other recourses are white of ^gg, milk,, 
sweet oil, emetics, and the use of the stomach-pump. A mustard 
plaster, with a little opium added to allay the pain and irritation,, 
may be applied over the pit of the stomach as a counter-irritant. 
Should vomiting have already occurred, emetics should be with- 
held. 

Chronic poisoning usually results from long-continued use of 
the medicine. The symptoms are the same as those of acute poi- 
soning, with the following superadded : paresis of the limbs, paral- 
ysis, incoordination of muscles, atrophy of the liver, with fatty 
degeneration of the liver-cells, and proliferous growth of the con- 
nective tissue. There may also be present congestion of the lungs 
and fatty degeneration of the kidney, together with bronchial 
catarrh. The treatment is the same as for acute poisoning. 

Therapeutics. — Externally and Locally. — Copper sulphate: 
stimulates old, flabby, gramdating rdce^'S. Ring-worm, scabies, and 
tinea sycosis derive great benefit from its use. 

The crystal or solution, 2 grains to i ounce (0.12-32.0 Gm.) of 
water, is used extensively in conjinictivitis, tinea tarsi, and trachoma 
condylomata, and as a gargle in relaxed sore throat. The aphthae 
in aphthous stomatitis are benefited by touching with the copper- 
sulphate solution. It is also used as an injection in gonorrhea and 
gleet, 2 grains to i ounce (0.12-32.0 Gm.). It is also valuable in 
mercurial sore mouth and gangrene of the pharynx. 

Internally. — Copper sulphate is the chemical antidote for 
phosphorus-poisoning, yet it should be given with great caution,. 



ASTRINGENTS. 741 

lest of itself it produce acute poisoning. It is a speedy emetic, 
since it acts directly upon the stomach. If emesis is not produced 
by the first dose, sulphate of zinc or mustard may be employed. 
It is used as an emetic in crotcp. 

In chorea, hysteria, and epilepsy copper is beneficial. In chronic 
dysenteiy and diarrhea an enema of a pint of water (512.0 Gm.) 
and 10 grains (0.6 Gm.) of sulphate of copper is an efficient 
remedy, being by some authors considered the best metallic 
astringent in chronic dysentery. 

Copper associated with arsenic is highly beneficial in anemia, 
building up the blood and adding firmness to the flesh, 

Oleate of copper is used in the skin affections mentioned. 

Nitrate and acetate of copper act like the sulphate. 

Arsenite of copper has been suggested as a remedy in anemia, 
and has been used in doses of yio" grain (0.0006 Gm.) in diarrhea 
and cholera i?ifantiim. 

Administration. — For an enema in diarrhea and dysentery it 
maybe combined with opium — 2 grains to i ounce (0.12-32.0 Gm.) 
of water being used. For eye affections the crystal or solution 
is employed. In addition to the enema copper sulphate, i grain 
(0.06 Gm.) may be united with magnesium sulphate i ounce 
(32.0 Gm.) and i drachm (4.0 Gm.) diluted sulphuric acid in 4 
ounces (128.0 Gm.) of water, a tablespoonful of the mixture being 
given every three or four hours. To produce emesis 10-15 grains 
(0.6-1 Gm.) are dissolved in about 5 ounces (160.0 Gm.) of water, 
a tablespoonful being given every ten minutes until vomiting is 
produced. 

Arg-enti Cyanidum— Argrenti Cyanidi— Silver Cya- 
nide. 77. S. P. 

Origin. — Obtained by distilling a solution of Potassium Ferro- 
cyanide acidulated with Sulphuric Acid, the distillate passing into 
a receiver containing a solution of Silver Nitrate. The process 
should be continued until the distillate no longer produces a 
precipitate in the receiver. The precipitate is finally washed with 
distilled water and dried. 

Description and Properties. — A white powder, without odor 
or taste ; permanent in dry air, but gradually turning brown on 
exposure to light. Insoluble in water, alcohol, or cold nitric acid ; 
soluble in boiling nitric acid, ammonia water, and solution of 



742 A TEXT-BOOK OF MATERIA MEDIC A, 

sodium hyposulphite or potassium cyanide. It should be kept in 
dark, amber-colored vials, protected from light Not used internally. 

Official Preparation. 

Acidum Hydrocyanicum Dilutum — Acidi Hydrocyanici Diluti — Diluted 
Hydrocyanic Acid (Prussic Acid). — Dose, 2-5 minims (0.12-0.3 Gm.). (Described 
under Hydrocyanic Acid, page 519.) 

Argrenti lodidum— Argenti lodidi— Silver Iodide. 

V. S. P. 

Orig-in. — Prepared from Silver Nitrate and Potassium Iodide, 
washing and drying the precipitate. 

Description and Properties. — A heavy, amorphous, light-yel- 
lowish powder, unaltered by light if pure, but generally becoming 
somewhat greenish-yellow ; without odor or taste. Insoluble in 
water and alcohol. Silver iodide should be kept in dark, amber- 
colored vials, protected from light. 

Dose. — i-i grain (0.015-0.06 Gm.). 

Arg-enti NItras— Argenti Nitratis— Silver Nitrate. 

U. S. JP. 

Orig-in. — Obtained by dissolving Silver in Nitric Acid with the 
aid of heat, evaporating, and crystallizing. 

Description and Properties. — Colorless, transparent, tabular, 
rhombic crystals, becoming gray or grayish-black on exposure to 
light in presence of organic matter. Without odor, but having a 
bitter, caustic, and strongly metallic taste. Soluble in 0.6 part of 
water and in 26 parts of alcohol. It should be kept in dark, 
amber-colored vials, protected from light. 

Dose. — l-i grain (0.015-0.06 Gm.). 

Official Preparations. 

ArgSnti Nitras Dilutus — ArgSnti Nitratis Diliiti — Diluted Silver Nitrate 

(Mitigated Caustic). — Origin. — Prepared by fusing together Silver Nitrate 30, and 
Potassium Nitrate 60, and casting in suitable moulds. 

Description and Properties. — A white, hard solid, generally in the form of pencils 
or cones of a finely granular fracture, becoming gray or grayish-black on exposure to 
light in the presence of organic matter; odorless, having a caustic, metallic taste, neutral 
to litmus-paper. It should be kept in dark, amber-colored vials. Used externally. 

ArgSnti NTtras Fiisus — Arggnti Nitratis Fusi — Moulded Silver Nitrate 
(Lunar Caustic). — Origin. — Obtained by melting Silver Nitrate 100, Hydrochloric 
Acid 4, and pouring the melted mass into suitable moulds. 

Description and Properties, — A white, hard solid, usually cone- or pencil-shaped, of 



ASTRINGENTS. 743 

a fibrous fracture, becoming gray or grayish-black on exposure to light in presence of 
organic matter ; odorless, having a bitter, caustic, and strongly metallic taste. Soluble 
in 0.6 part of water and in 26 parts of alcohol. The product should be kept in dark, 
amber-colored vials, protected from light. Used externally and locally. 



Arg-enti Oxidum— Argenti Oxidi— Silver Oxide. 

77. >S^. J>. 

Origin. — Prepared by shaking a solution of Silver Nitrate with 
solution of Potassa and washing the precipitate. 

Description and Properties.— A heavy, dark, brownish-black 
powder, hable to reduction by exposure to light; odorless, with a 
metallic taste; very sHghtly soluble in water and insoluble in 
alcohol. 

Dose. — J-2 grains (0.03-0.12 Gm.). 



Antagonists and Incompatibles. — The silver nitrate is incom- 
patible with the alkalies and their carbonates, chlorides, hydro- 
chloric and tannic acids, potassium iodide, solutions of arsenic, and 
many of the organic acids. 

Silver oxide is rapidly oxidized, forming explosive compounds 
with chlorides and organic substances. 

Synergists. — Preparations of copper, lead, and zinc aid the 
action of silver salts. 

The silver nitrate and its preparations and the silver oxide are 
the only salts which possess any value as astringents or caustics. 
The silver nitrate is the typical astringent salt, and its physiological 
action will be hereafter considered. 

Physiological Action. — Metallic silver is practically of no use 
in medicine, though of great value in surgery, because of its inert- 
ness. Silver nitrate is the salt of silver chiefly employed. 

Externally and Locally. — It is a powerful caustic, but does not 
wound very deeply, as it forms an eschar by coagulating the albu- 
min of the tissue, thus protecting the underlying structures. The 
eschar is white, but on exposure to light very soon becomes black, 
owing to the fact that the silver is reduced to its metallic state. 

Like lead salts, silver salts are hemostatic. They are severely 
irritant to mucous membranes when used in solution. 

Internally. — Digestive System. — The drug causes increased secre- 
tion of intestinal glands and larger flow of bile. Silver salts are 
changed in the stomach into peptonates and albuminates. Under 



744 ^ TEXT-BOOK OF MATERIA MEDIC A. 

ordinary doses nutrition is promoted ; by large doses it is impaired, 
with resulting loss of flesh and weight. 

Circulatory System. — The heart is stimulated by small doses, 
and the blood becomes darker and contains less fibrin. The 
red corpuscles lose shape and color and the hemoglobin is con- 
verted into hematin. Large doses depress cardiac action, while 
thrombosis and emboHsm may ensue. 

Nervous System. — In small doses silver salts are tonic ; in large 
doses they produce epileptiform convulsions and paralysis of centric 
origin. 

Respiratory System. — -The primary effect of the drug is to stim- 
ulate respiration. Large doses, however, cause death by paralysis 
of the respiratory center. 

Absorption and Elimination. — It is absorbed from the stomach 
and eliminated very slowly, chiefly by the feces, a small portion 
being excreted by the kidneys. 

Temperature. — At first increased ; afterward, through the blood- 
changes, lowered. 

Untoward Action. — Long-continued use of silver nitrate pro- 
duces discoloration of the skin — either general or more pronounced 
in particular spots, such as the face. Even when the skin is per- 
fectly intact the appHcation of nitrate of silver will discolor it, 
\ grain (.016 Gm.) having caused palpitation of the heart and irreg- 
ular pulse. Silver is very apt to accumulate in the tissues. 

Poisoning. — A poisonous dose of silver nitrate produces a violent 
gastro-enteritis. The earliest symptom is an intense pain in the 
abdomen, followed by vomiting and purging. The abdominal 
muscles are hard and retracted, the face livid and covered with 
perspiration and wearing an anxious expression. The lips are 
blanched, gradually becoming black ; the vomited matter is black- 
ish and sometimes resembles milk-curds. 

Epileptiform convulsions, dehrium, and paralysis ensue, the 
latter symptom being of centric origin. 

Death results from cessation of respiration, due to the centric 
paralysis. A large amount of mucus is thrown into the bronchial 
tubes by the lining mucosa. 

Treatment of Poisoning. — The chemical antidote is common salt. 
It is essential to protect the mucous mem.brane of the esophagus 
and stomach, and at the same time dilute the poison as much as 
possible, for which purposes large quantities of salt water and soap 
water or milk are valuable. Opium allays the pain and irritation. 



ASTRINGENTS. 745 

Chro7iic poisonings or argyria, results from prolonged medicinal 
use of silver nitrate or its employment as a hair-dye for any length 
of time. The drug is deposited in all parts of the body, being 
especially manifest in a slaty, permanent discoloration of the skin. 
The first symptoms are discoloration of the sclerotic conjunctivae 
and a dark line on the inner side of the lips. Ulcerative stomatitis 
may occur, or even gastric ulcer. 

Treatment of Chronic Poisoning, — Iodide of potassium or hypo- 
sulphite of soda will aid in eliminating the poison. Baths of the 
hyposulphites or lotions of cyanide of potassium may produce 
absorption and excretion of the silver deposits, but the discolora- 
tion is rarely removed in any way. 

Therapeutics. — Externally and Locally. — A very important use 
■of SILVER NITRATE is that of preventing ophthalmia neonatorum, 
a 2 per cent, solution being dropped into the eyes. For adults a 2 
to 4 per cent, solution is used in various forms of conjunctivitis, the 
•eyelids being painted with a camel's-hair brush, and the solution 
being washed off immediately to prevent discoloration. The nitrate- 
•of-silver stick may also be used. 

Felons, boils, and bed-sores may be aborted by the use of a strong 
solution — 20 grains to i ounce — of silver nitrate. 

An injection of 2-3 grains (.12-20 Gm.) is beneficial in snbacnte 
gonorrhea and leucori'hea. This may also be used as a wash in 
prtiritus ani and vidvcE, to relieve the itching. The stick may be 
applied to uterine tdccrs. 

As a caustic it is used in indolent idcers and chancroids, stimu- 
lating them and producing a healthy granulating surface. 

A solution painted over the eruption of variola is supposed to 
prevent pitting. The vesicles may also be punctured with a needle 
and the silver nitrate then introduced. 

The pain and swelling of orchitis and epididymitis are consid- 
erably relieved by painting the scrotum with a solution of this 
salt. 

After a cold, when the throat feels raw and sore, a gargle of 60 
grains (4.0 Gm.) to the ounce (30.0 Cc.) is very gratifying, and the 
same may be used in inflammations of the pharynx, fauces, and 
mouth. A spray of 40 grains (2.59 Gm.) to the ounce (30.0 Cc.) 
is very effective in laryngeal ci'oup, trachitis, chronic ulceration of the 
larynx, and whooping cough. The caustic pencil is used in tonsil- 
litis, sore 7iipples, mercurial sore mouth, and poisoned, lacerated, and 
punctured wounds. A solution of 1-2 grains (.06-. 12 Cc.) to the 



746 A TEXT- BOOK OF MATERIA MEDIC A. 

ounce (30.0 Cc.) is valuable in otorrhea, vesical catarrh, and 
balanitis. 

Internally. — Dr. Pepper recommends this salt in intestinal ulcer- 
ations, given in keratin-coated pills. It is a cure for gastric ulcer, 
in which it may be combined with opium. Gastralgia and chronic 
gastritis, ulceration of the rectum, dysentery, and diarrhea of typhoid 
have been remarkably benefited by its use. For stomach affections 
■J— ^ grain (.01-016 Gm.) is given, and for intestinal an enema of 
3-10 grains (.20-64 Gm.) to the ounce (30.0 Cc). 

It has been used in congested conditions of the cord, locomotor 
ataxia, epilepsy, and chorea. It is the only remedy of any value in 
locomotor ataxia ; but, owing to the discoloration it produces, it 
cannot be used continuously, and in many cases it fails entirely. 

Argentic iodide was once used extensively in the treatment 
of syphilis, but is now obsolete. 

Argentic oxide is not so active as the nitrate. It has been 
employed for checking sweats, and, owing to its less caustic action^ 
it may be preferable to the nitrate in gastric idcer and gastralgia. 

Administration. — The dose of silver nitrate is -J— J grain (.01- 
.016 Gm.), and for a constitutional effect should always be given in 
pill form during the process of digestion. 

The keratin-coated pill is to be administered for intestinal dis- 
orders, and when a local action on the alimentary canal is desired 
an ordinary pill should be given one to two hours before meals. 

It is well to discontinue the drug for a short time after three or 
four weeks' treatment, the salt being so slowly eliminated that its 
prolonged use is very apt to result in argyria. 

Argonin. — Origin. — A soluble compound of Silver and Casein, first prepared by 
Rohmann and Liebreich. 

Description and Properties. — A dilute solution of this substance in water is opales- 
cent ; opaque when concentrated, but immediately cleared by the addition of ammonia 
or carbonate of soda. Used externally and locally. 

Physiological Action and Therapeutics. — Argonin is a very powerful, non-irritating- 
germicide. The addition of a little ammonia to a solution of argonin vastly increases 
its bactericidal power, but deprives the drug of its bland, non-irritating character. It 
appears to lack astringent properties, and concentrated solutions are neither corrosive 
nor irritant. 

From experimental research Meyer concludes that argonin has a strong disinfecting 
influence upon certain bacteria, particularly the gonococcus, investigation having shown 
that a I : 30,000 solution of ammoniacal argonin completely suspended the growth of 
this microbe for five minutes. 

Judassohn, who has had an extensive experience with argonin in the treatment of 
gonorrhea, draws the following conclusions : (i) 1.5 to 2 per cent, solutions exert a rap- 
idly destructive action upon gonococci. (2) Strong solutions are devoid of inflammatory 



ASTRINGENTS. 747 

or corrosive action, and are consequently adapted to the treatment of acute gonorrhea 
of the anterior and posterior urethra in men, and of the uterus and urethra in women. 
(3) It appears to lack astringent properties, so that purely anticatarrhal treatment will 
indicate the assistance of other remedies. 

Alumen— Aluminis— Alum. JJ. S, P. 

Orig-in. — Prepared by a complicated process from a mixture of 
Aluminum Silicate and Iron Sulphide by roasting, lixiviating with 
water, concentrating the solution, and, while hot, mixing with Po- 
tassium Chloride. Upon cooling the alum separates as a crystal- 
line powder, which is purified by one or two recrystallizations. 

Description and Properties. — Large, colorless, octahedral crys- 
tals, sometimes modified by cubes, or crystalline fragments, without 
odor, but having a sweetish and strongly astringent taste. On 
exposure to the air the crystals are liable to absorb ammonia and 
acquire a whitish coating. Soluble in 9 parts of water and 0.3 part 
of boiling water ; also freely soluble in warm glycerin. Insoluble 
in alcohol. 

Dose. — 5-40 grains (0.3-2.60 Gm.) ; as an emetic, 1-2 drachms 
(4.0-8.0 Gm.). 

Official Preparation. 

Alumen Exsiccatum — Aluminis Exsiccati — Dried Alum (Burnt Alum). — 
Origin. — Alum heated until it is deprived of its water of crystallization. 

Description and Properties. — A white, granular powder, without odor, possessing a 
sweetish, astringent taste and attracting moisture from the air. Very slowly but com- 
pletely soluble in 20 parts of water, and quickly soluble in 0.7 part of boiling water. 

Dose. — 1-5 grains (0.06-0.3 Gm.). 

Unofficial Preparation. 

Aluminis Glyceritum— Aluminis Glyceriti— Glycerite of Alum (20 per cent, 
alum). — Used externally. 

Allied Compounds. 

Aliimnol— Altimnol— Alumnol.— (9rzVm.— This substance was discovered by 
Filehne of Breslau, and is a mixture of Aluminum Salts of Naphthol-sulphonic Acid, 
containing about 5 per cent, of aluminum and 15 per cent, of sulphur. 

Description and Properties.— \\. occurs as a light, odorless, white or reddish- white, 
non-hygroscopic powder. It possesses a sweetish and astringent taste, and is readily 
soluble in water or glycerin, less so in alcohol, and insoluble in ether. 

While becoming darker on exposure to the air, its properties are unaffected. Used 
externally and locally. 

Aluminum Aceto-tartrate.— (9r?Vz«.— First prepared by Athenstadt by dissolving 
5 parts of Basic Aluminum Acetate in a sufficient quantity of water by the aid of 2 parts 
of Tartaric Acid, and evaporating the solution to dryness. 



748 A TEXT-BOOK OF MA TERIA MEDICA. 

Description and Properties. — It occurs in shining, almost colorless, amorphous 
masses, with a faint, acetous odor and an acidulous astringent taste. Soluble in water; 
insoluble in alcohol. Used externally and locally. 

Aluminum Boroformate. — Origin. — Prepared by heating together Boric Acid, 
Formic Acid, and Alumina. 

Antagonists and Incompatibles. — The alkalies and their car- 
bonates ; lead, mercury, and iron salts ; tartrates and tannic acid. 
Synergists. — The vegetable and. mineral astringents. 

Alumini Hydras— Alum ini H yd ratis— Aluminum 
Hydrate. V.H.IP. 

Origin. — This substance is found in nature as the rare crystal- 
line mineral gibbsite of North America — the diaspore of Eastern 
Europe. The aluminum hydrate may be prepared by precipitating 
the solution of an aluminum salt with an alkali or alkali carbonate. 

Description and Properties. — A white, light, amorphous pow- 
der, odorless and tasteless, permanent in dry air. Insoluble in 
water or alcohol, but completely soluble in hydrochloric or sul- 
phuric acid, and also in potassium or sodium hydrate T. S. 

Dose. — 3-6 grains (0.2-0.4 Gm.). 

Alumini Sulphas— Alumini Sulphatis— Aluminum 
Sulphate. V. S. P. 

Origin. — It is occasionally found as an efflorescence near vol- 
canoes and upon alum-slate. For medicinal use it should be pre- 
pared from Aluminum Hydrioxide, by dissolving it in the requisite 
quantity of Dilute Sulphuric Acid. 

Description and Properties. — A white, crystalline powder, 
having a sweetish and afterward astringent taste ; pennanent in the 
air. Soluble in 1.2 parts of water, and much more freely in boiling 
water ; insoluble in alcohol. Used externally. 

Description and Properties. — It occurs in pearl-like crystals 
or crystalline scales, which are very soluble in water. It contains 
33.5 per cent, of alumina. Used externally and locally. 

Sozal. — 07'igin. — Obtained by dissolving Aluminum Hydrate in Phenol-sulphonic 
Acid. 

Description and Properties. — A crystalline substance having an astringent taste and 
a faint odor of carbolic acid. It is freely soluble in water, glycerin, and alcohol. Used 
externally and locally. 

Physiological Action. — Externally and Locally. — Alum con- 
tracts the small blood-vessels and coagulates the albumin in the 



ASTRINGENTS. 749 

tissues, but in order to have any effect it must be applied to a 
denuded surface. It is also mildly escharotic. Applied to the 
unbroken skin, it thickens and hardens it. 

Internally. — Digestive System.— \X.?> first effect when taken into 
the mouth is to excite the salivary secretion, the albumin in it, as 
well as that of the buccal mucous membrane, being precipitated. 
When its astringent action takes effect the secretions are dimin- 
ished and the mucous membrane of the mouth and tongue is 
blanched and puckered. The enamel of the teeth is affected, 
breaking under its influence. 

The digestive juices are diminished in quantity and the pepsin 
precipitated. Constipation follows, though it may be preceded by 
a slight diarrhea. 

Taken in large doses, alum produces nausea, vomiting, purging, 
and abdominal pain. 

Circulatory System. — Notwithstanding the fact that alum coag- 
ulates albumin, it is nevertheless absorbed into the blood-vessels, 
and by contracting them lessens all the secretions and arrests 
hemorrhage. When injected directly into the blood it produces 
thrombi and emboli. 

Nervous System. — Spasms are relieved by alum, but this action 
is in all probability dependent upon contraction of the blood- 
vessels. 

Absorption and Eliniination. — As stated, alum is absorbed by 
the blood-vessels ; it is eliminated by the kidneys and liver. 

Untoward Action. — The prolonged use of alum is very apt to 
produce a cough in persons having sensitive bronchi. 

Therapeutics. — Externally and Locally. — Alum is used to de- 
stroy exuberant granulations and verrucositics. It is an excellent 
hemostatic in epistaxis and bleeding from the gums, vagina, rectum, 
bladder, bites, and sockets of extracted teeth. 

It is much used for sore throat by public speakers and singers, 
and is also efficient in tonsillitis, particularly the follicular form, 
gangre7ious pharyngitis, stomatitis idcerosa, relaxation of the uvula 
and pharyngeal mucous membrane, swollen and overriding gums, 
and mercurial ptyalism. 

The destructive effect of alum upon the teeth must always be 
borne in mind : the alum stick or a swab is preferable whenever 
possible. If a mouth-wash or gargle be necessary, wash and brush 
the teeth well immediately after using the alum. 

Five grains (.32 Gm.) to i ounce (30.0 Cc.) of water is an excel- 



750 A TEXT-BOOK OF MATERIA MEDICA. 

lent preparation for ophthalmia, conjtmctivitis, and trachoma, but 
must not be used if there is any corneal inflammation, as it is apt 
to cause ulcers. By adding milk or white of ^^^ to the mixture 
its efficiency is greatly increased. This preparation is also very 
serviceable in preventing the discoloration of a '* black eye." An 
injection of 5-10 grains (.32-64 Gm.) to the ounce (30.0 Cc.) of 
water is much used in gonorrhea, leucorrhea, and gleet, and also 
for washing the vulva in pruritus. 

Sweating of feet, haiids, arid axillce, when excessive and fetid, is 
checked by the application of a lotion or powdered alum. 

Soaking a piece of cotton or lint with alum and placing it under 
an ingrowing toe-nail affords marked relief 

Chilblains, old sores, and idcers are also benefited by the use of 
alum. 

A spray, gargle, or insufflation has been used with good results 
in diphtheria^ bronchorrhea, chronic laryngitis, aphonia due to atony, 
bronchitis, and whooping cough. 

Internally. — Alum operates advantageously as an astringent in 
arresting gastric and intestinal hejnorrhages, hematuria, and menor- 
rhagia. The diandieas of typhoid fever and chronic dysentery, and 
occasionally the acute forms, are strikingly benefited by an alum 
enema. 

It has been used in polyuria and diabetes mellitus, though in the 
later affection it is of little value. 

Although alum produces, it also reHeves, co?istipation when 
flatus has existed for some time, and atony of the bowel diminished 
peristalsis. 

Given in emetic doses in membranous croup, it loosens the 
membrane, and as this is expelled it lessens the chance of another 
one forming by constringing the mucosa and blood-vessels, and 
thus preventing further exudation. 

By checking absorption and producing emesis alum serves as an 
antidote for lead-poisoning, and is an efficient remedy in lead colic. 

Alumen exsiccatum is employed chiefly as an escharotic for 
fungous growths, and to stimulate indolent ulcers and mucous 
membranes with morbid secretions. 

Whenever the drug is used as a powder externally or for insuf- 
flation, powdered dried alum is the form to use. 

Adrainistration. — The emetic dose of alum is 1-2 drachms 
(4.0-8.0 Gm.) in syrup. Warm water will increase its action when 
retching begins. 



ASTRINGENTS. 751 

For internal use, 5-10 grains (.32-.64 Gm.), mixed with a little 
simple syrup or syrup of orange peel to prevent nausea, will be 
found beneficial. For collyria, 2-3 grains (.12-20 Gm.) in i ounce 
(30.0 Cc.) of water, or the alum curd, as already mentioned, may 
serve best. The curd may be separated by adding 2 drachms (8.0 
Gm.) of alum to i pint (473. Cc.) of milk, boiling, and straining. 

The gargle and injection can be used in strengths of 5-20 grains 
(.32-1.29 Gm.) to I drachm (4.0 Gm.). For insufflation the dried 
alum is employed. 



Bismuthi CTtras— Bismuthi Citratis— Bismuth Ci- 
trate. V. S. JP. 

Origin. — Bismuth Subnitrate and Citric Acid are boiled in suf- 
ficient Water, and the precipitate washed and dried. 

Description and Properties. — A white, amorphous or micro- 
crystalline powder, odorless and tasteless, permanent in the air. 
Insoluble in water or alcohol, but soluble in ammonia water and in 
solutions of the citrates of the alkalies. 

Dose. — 1-3 grains (0.06-0.2 Gm.). 

Official Preparatioji. 

Bismuthi et Ammonii Citras — Bismuthi et Ammonii Citratis — Bismuth 
and Ammonium Citrate. — Origm. — Prepared by mixing Bismuth Citrate with Dis- 
tilled Water to make a paste, adding sufficient Ammonia Water to make a solution, filter- 
ing, evaporating, and drying on plates of glass. 

Description and Properties. — Small, shining, pearly, or translucent scales, odorless, 
with a slightly acidulous and metallic taste, becoming opaque on exposure to the air. 
Very soluble in water, but sparingly soluble in alcohol. The product should be kept in 
well-stoppered bottles, protected from light. 

Dose. — i-io grains (0.06-0.6 Gm.). 

Bismuthi Subcarbonas— Bismuthi Subcarbonatis— 
Bismuth Subcarbonate. TJ. S. JP. 

Origin. — Obtained by dissolving purified Bismuth in Nitric 
Acid and Water, decanting and filtering, mixing with Ammonia 
Water, washing the precipitate and dissolving in Nitric Acid. The 
solution is then mixed with a solution of Sodium Carbonate, and 
the resulting precipitate collected and washed. 

Description and Properties. — A white or pale yellowish-white 
powder, of somewhat varying chemical composition, odorless and 
tasteless, permanent in the air. Insoluble in water or alcohol, but 



752 A TEXT-BOOK OF MATERIA MEDICA. 

completely soluble in nitric or hydrochloric acid, with copious 
effervescence. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Bismuthi Subnltras— Bismuth! Subnitratis— Bis- 
muth Subnitrate. U,S,JP. 

Origin. — Prepared by dissolving purified Bismuth in Nitric Acid 
and Water, concentrating by evaporation, adding more water, stir- 
ring well, and washing and drying the precipitated bismuth sub- 
nitrate. 

Description and Properties. — A heavy white powder, of some- 
what varying chemical composition, odorless and almost tasteless, 
permanent in the air. Nearly insoluble in water and insoluble in 
alcohol, but readily soluble in nitric or hydrochloric acid. 

Dose. — 5-20 grains (0.3-1.2 Gm.). 

Allied Compounds. 

Bismuthi Salicylas — Bismuthi Salicylatis — Bismuth Salicylate. — Dose, i- 
20 grains (0.06-1.2 Gm.). 

Bismuthi Subiodidum— Bismuthi Subiodidi — Bismuth Subiodide. — Used 

externally. 

Bismuth Naphtholate. — Dose, 15-30 grains (1.0-2.0 Gm.). 

Bismuth Tribromphenate. — Dose, 60-75 grains (4.0-5.0 Gm.). 

Dermatol (Bismuth Subgallate). — DesaHption and Properties. — A fine saffron- 
yellow powder, odorless, non-hygroscopic, unaffected by exposure to air or light, insoluble 
in water, alcohol, or ether. 

Dose. — 15-30 grains (1.0-2.0 Gm), 

Dermol (Bismuth Chrysophanate). — Description and Properties. — An amor- 
phous yellow powder, neutral in reaction, insoluble in water or alcohol. Used externally 
and locally. 

ThToform. — A combination of Bismuth, Sulphur, and Sahcyhc Acid, 
Description and Properties. — A light, grayish-yellow powder, odorless and tasteless, 
insoluble in water, alcohol, or ether. Used externally and locally. 

Antagonists and Incompatibles. — The salts of bismuth are 
insoluble, and should not be prescribed with other agents in 
solution. 

Synergists. — The sedative action of bismuth upon the stomach 
may be increased by calomel and cerium oxalate, and pepsin may 
be given as a substitute for this purpose. The astringency of the 
bismuth salts may be enhanced by opium and tannic acid. 

Physiological Action. — Externally. — Bismuth salts are mildly 
astringent, but have no effect upon the unbroken skin. 

Internally. — Digestive System. — Bismuth is insoluble in the 



ASTRINGENTS. 753 

gastro-intestinal juices. It coats the mucous membrane, lessening 
secretions and absorbing excess of free acids, at the same time act- 
ing as a sedative and feeble astringent. The tongue and stools are 
tinged a dark clay color, due to .conversion into the sulphide. The 
soluble salts are absorbed very slowly, and increase the appetite 
and digestion, constipation being the result. 

Circulatory System. — A minute quantity passes into the blood, 
acting as a tonic. 

Nervous System. — Bismuth salts are sedative to the peripheral 
nerve-endings. 

Absorption and Elimination. — The salts of bismuth are absorbed 
into the circulation, and are eliminated by the urine, liver, and feces. 

Untoward Action. — Odier noticed nausea, and Weenesk vomit- 
ing, colicky pains, diarrhea, or constipation, headache, sensation of 
heat, dizziness, and general debility. 

Poisoning. — It has always been assumed that cases of poisoning 
are due to the lead and arsenic contained in the bismuth prepara- 
tions, but Carnot and Riche found these metals present in such 
quantities as to be practically inert. 

The symptoms are similar to those of lead-poisoning. Large 
concretions may be found in the intestines, and sloughs in the 
mouth and gastro-intestinal canal may be present, as well as 
desquamative nephritis and albuminuria. 

Treatment of Poisoidng. — Lavage, demulcents, and chemical anti- 
dotes for arsenic, magnesium, and calcium ; best of all, freshly 
precipitated hydrated oxide of iron. 

Therapeutics. — Externally and Locally. — Bismuth subnitrate 
is serviceable in intertrigo, erythema, ac7ie rosacea, as a protective 
dressing for wotinds, tdcers, and epitlielioma, and as an application 
for chapped nipples and hands, relieving the smarting and itching. 
It is also of use in fissure, prolapsus ani, and superficial burns. 

It is used as an injection in goiiorrhea, leucorrhea, and ozena, 
and was formerly used as an insufflation in acute nasal catarrh, 
being abandoned because of the arsenic w^hich it sometimes con- 
tains. It serves as a wash in aphthous stomatitis, mild cases of 
mercurial salivation, and cancrum oris, as well as for the fetid 
sweating of feet and other parts, and for chancres and phlegmonous 
erysipelas. It has also proved beneficial in chronic conjunctivitis 
and granular lids or trachoma. 

Internally. — It allays irritation, and is consequently useful in 
irritative vomiting and diarrhea. Gastric paiii is relieved by it. 

48 . 



754 ^ TEXT-BOOK OF MATERIA MEDICA. 

It is valuable in pyrosis, chronic diarrhea, gastric ulcer, chronic 
dysentery, diarrhea of typhoid, early stages of cholera and cholera 
infantum, and in the gastritis due to alcohol. 

The CITRATE OF BISMUTH AND AMMONIUM is very soluble, and 
should be used only for local applications. 

The OXIDE is insoluble, and combined with morphine has been 
used as a snuff in ozena and nasal catarrh. 

SuBCARBONATE OF BISMUTH is not used in medicine. 

Salicylate of bismuth reduces the pulse and temperature in 
typhoid fever, and also corrects the fetid stools. 

Bismuth subgallate, or dermatol, was first used by Heintz 
and Liebrecht, being intended as a substitute for iodoform ; but it 
is very astringent, although not irritating. The preparation is used 
in weeping eczema, otitis media, herpes, wounds, burns, diarrhea, and 
dysentery. In stagnant ulcers it is of no service, since they need 
stimulation. 

Bismuth citrate is insoluble, and is of no service medicinally. 

Besides the foregoing preparations there is a tannate of bis- 
muth, used to some extent in diarrhea, gonorrhea, leucorrhea, and 
ophthalmia. 

Phosphate of bismuth is the least soluble of all the bismuth 
compounds, and is used, but rarely, in diarrhea, dysentery, gastral- 
gia, and dyspepsia. 

SuBiODiDE OF BISMUTH is used as a substitute for the subnitrate, 
and is of special value in chronic ulcers. It is supposed to be 
slightly anesthetic. 

Valerianate of bismuth is of no medicinal value. 

Subbenzoate of bismuth is mildly escharotic. 

Administration. — The drug is used externally as a powder or 
ointment in combination with naphthalin or vaseline, to which a 
little morphine may be added. Belladonna, opium, and oleate of 
bismuth are also used. 

For gastralgia and dyspepsia, pepsin or magnesium and calcium 
phosphate may be combined with bismuth. If a cathartic is desir- 
able, rhubarb may be added. 

Bismuth, aromatic powder, and carbo ligni make an excellent 
combination in flatulent dyspepsia. 

In infantile diarrhea and summer complaint bismuth i grain 
(.06 Gm.), syrupus aurantii 15 minims (.92 Cc), and calumba 15 
minims (.92 Cc.) are efficacious, particularly as they allay the 
alternating pain. 



ASTRINGENTS. 7SS 

Bismuth, 5-15 grains (.32-1.0 Gm.), is given for stomach affec- 
tions, and 15 grains (i.o Gm.) to i drachm (4.0 Gm.) for intestinal 
disorders, one to two hours after meals as the stomach is emptied. 

Cerii Oxalas— Cerii Oxalatis— Cerium Oxalate. 

77. S. jP. 

(Cerous Oxalate.) 

Origin. — Prepared by a compHcated process by the action of 
acids, etc. upon the powdered mineral. 

Description and Properties. — A white, granular powder, with- 
out odor or taste, and permanent in the air. Insoluble in water, 
alcohol, or ether. 

Dose. — 1-8 grains (0.06-0.5 Gm.). 

Physiological Action. — The physiological action of this drug 
is imperfectly understood : it is supposed to be a nervous sedative. 

Therapeutics. — Internally. — Its widest application is in the vom- 
iting of pregnancy, but it also controls the emesis of uterine disease 
and of dyspepsia, due to gastric acidity or deranged innervation of 
the stomach, as in sea-sickness. 

It does not derange digestion, and is therefore of value in 
checking the cougli of phthisis and bronchitis, especially when 
accompanied by vomiting. 

Simpson regarded it as almost a specific in chorea. In combi- 
nation with bismuth it is useful in checking diarrhea. 

Administration. — Cerium oxalate is usually administered in pill 
form, 1-3 grains (.06-20 Gm.) three times daily, but the powder 
is used when the drug is associated with other remedies. 



I 



TOPICAL REMEDIES. 

GROUP XVIIL— CAUSTICS OR ESCHAROTICS. 

Caustics are medicines which destroy the tissues to which they 
are appHed. They excite inflammation and vascular dilatation of 
the surrounding area. The eschar produced by these drugs is 
separated from the living tissues by the inflammation and suppura- 
tion produced. 

When a drug acts as a caustic — that is, when it destroys a cir- 
cumscribed portion of living tissue — it penetrates deeper in pro- 
portion as the product of its action {i. e. the eschar) is looser, and 
is shallower in proportion as the eschar is firmer or more com- 
pact. This is the essential difference between Astringents and 
Caustics : the former contract the tissues, causing the protoplasm 
to be firmer and occupy less space ; the latter cause the protoplasm 
to be softer and occupy more space. It will be seen, therefore, 
that the more caustic a drug is, the less astringent it is, and vice 
versa. 

The caustic action of a drug depends upon whether the drug 
and its products are both soluble in water ; for if the medicine is 
not soluble in water, it cannot have a caustic action, and if the 
products of the caustic action are not soluble in water, the eschar 
will be firm, the drug acting more as an astringent than as a 
caustic. 

For example, the chlorides of the heavy metals, such as mer- 
curic chloride, zinc chloride, etc., are usually freely soluble in 
water, and are, as a rule, the most caustic of the metallic salts. 
Should a metallic chloride be insoluble in water, it will have no 
caustic action — e.g. silver chloride. 

If the heavy metals be arranged in a series, placing at one end 
the most astringent salts, and at the other the least astringent, it 
will be noticed that those salts which are the least astringent are 
the most caustic, becoming less and less caustic as they are more 
and more astringent. 

Most Astringent. Least Astringent. 

Lead, Iron, Zinc, Copper, Silver, Tin, Mercury. 

Least Caustic. Most Caustic. 

756 



CAUSTICS OR ESCHAROTICS. J^j 

Caustics act — 

1. By abstracting- the water of the tissues ; 

2. By combining with the albumin of the tissues ; 

3. By corrosive oxidation. 

The important caustics, arranged according to their mode of 
action, are enumerated below. 

Gates tics which act by abstracting the water from the tissues : 
Arsenious Acid, Potassa and Lime, 

Antimony Chloride, Caustic Soda, 

CarboHc Acid, Glacial Acetic Acid, 

Chromic Acid, Lime, 

Caustic Potash, Mineral Acids. 

Caustics which act by combining with the albumin of the part : 
Alum (burnt). Mercuric Oxide, 

Copper Sulphate, Silver Nitrate, 

Mercuric Chloride, Zinc Chloride, 

Mercuric Nitrate, Zinc Sulphate. 

Caustic zvhicJi acts by corrosive oxidation : 
Bromine. 

Caustics are employed — 

1. To destroy excrescences on the skin or mucous membranes, 
and to effect the destruction or removal of malignant growths, as 
in cases of ivarts, condylomata, polypi, lupus, epithelioma, etc. ; 

2. To open abscesses, or to maintain a chronic irritation, or to 
stimulate indole?tt sinuses, idcers, etc. ; 

3. To destroy and prevent the absorption of the virus from the 
bites of rabid and venomous animals, and for the destruction of 
chancres and malignant pustides. 

Those escharotics w^hich have not been discussed elsewhere 
will now be considered in detail : 

Liquor Antimonii Chloridi— Liqu5ris Antimonii 
Chloridi— Solution of Antimony Chloride. (Unofficial.) 

(Butter of Antimony.) 

Origin. — Prepared by the action of Hydrochloric Acid upon 
Purified Black Antimony. 

Description and Properties. — A yellowish or yellowish-red 
liquid, having the specific gravity 1.47, and yielding with water a 
white precipitate of antimonious oxychloride {powder of AlgarotJi). 

Used externally as a caustic. 



75^ A TEXT-BOOK OF MA TERIA MEDICA. 

Physiological Action and Therapeutics. — Solution of anti- 
mony CHLORIDE is one of the most powerful caustics employed in 
surgery. It is a violent corrosive poison, toxic doses producing 
complete general collapse, corroding and charring any living tissue 
with which it comes in contact. The treatment of poisoning by 
butter of antimony would be — chalk, magnesia, demulcent drinks, 
tannic acid, anodynes, and stimulants if necessary. 

Solution of chloride of antimony may be used as a caustic 
for the bites of rabid animals and venomous reptiles, chancres, con- 
dylomata, malignant pustules, etc. 

The preparation should be cautiously applied with a camel's- 
hair pencil. 

Acidum Chromicum— Acidi Chr5mici— Chromic 
Acid. V.8.P. 

(Chromic Trioxide; Chromic Anhydride.) 

Origin. — Dissolve Potassium Bichromate in Sulphuric Acid 
and Water; decant, heat with more Sulphuric Acid; cool, and 
crystallize. 

Description and Properties. — Small, needle-shaped crystals 
or rhombic prisms, of a dark purplish-red color and metallic 
luster ; odorless ; destructive of animal and vegetable tissues ; 
deliquescent in moist air. Very soluble in water, forming an 
orange-red solution. When brought in contact with alcohol, 
ether, glycerin, and other organic solvents decomposition takes 
place, sometimes with dangerous violence. Chromic acid should 
be kept in glass-stoppered bottles, and great caution should be 
observed to avoid bringing it in contact with organic substances, 
such as cork, tannic acid, sugar, alcohol, etc., as dangerous acci- 
dents are liable to result. Used externally. 

Physiological Action and Therapeutics. — Chromic acid is 
a powerful caustic, deodorant, and disinfectant. It coagulates 
albumin and oxidizes organic matter. Its action is slow, and the 
pain following its application is usually of shorter duration than 
that of most caustics. Weak solutions are stimulant, astringent, 
and alterative. 

Chromic acid is used in the form of a paste or in solutions of 
various strengths for the removal of sypJiilitic warts, vegetations, 
condylomata, etc. As a caustic and stimulant application in many 
diseases of ear, nose, and throat it serves a valuable purpose, as in 
nasal polypi, enlarged tonsils, chronic and syphilitic laryngitis, laryn- 



CAUSTICS OR ESCHAROTICS. 759 

geal papillomata, chronic superficial glossitis, tuberculosis of the 
tongue, ozena, ulcerations of the mouth, etc. 

A 10 per cent, solution of chromic acid has been found service- 
able in the treatment of hyperidrosis. 

A solution of i part of chromic acid in 40 parts of water makes 
an efficient lotion for disinfecting /(?z// ?//<:^r^ and as an injection in 
gonorrhea, leucorrhea, etc. 

Sessile piles and salivary fistulce are efficiently treated by touch- 
ing the parts with pure chromic acid. 

Potassa— Potassae— Potassa. 77. H. IP. 

(Potassium Hydrate; Potassium Hydroxide; Caustic Potash.) 

Origin. — Prepared by evaporating Liquor Potassae, fusing the 
residue, and pouring into clean cylindrical moulds which have been 
previously warmed. 

Description and Properties. — Dry, white, translucent pencils, 
or fused masses, hard and brittle, showing a crystalline fracture ; 
odorless or having a faint odor of lye, and of a very acrid and 
caustic taste. Because of its active effect upon organic tissues it 
should be tasted and handled with exceeding care. Exposed to 
the air, it rapidly absorbs carbon dioxide and moisture, and 
deliquesces. Soluble in about 0.5 part of water and in 2 parts 
of alcohol. Potassa should be kept in well-stoppered bottles 
made of hard glass. Used externally. 

Potassa cum Calce— Potassae cum Calce— Potassa 
with Lime. TI.S.I'. 

(Vienna Caustic or Vienna Paste.) 

Origin. — Prepared by rubbing together equal parts of Potassa 
and Lime in a warm iron mortar. 

Description and Properties. — A grayish-white powder, deli- 
quescent, having a strongly alkaline reaction. Used externally. 

S5da— Sodae— Soda. U. S. I*. 

(Sodium Hydrate; Sodium Hydroxide; Caustic Soda.) 

Origin. — Prepared from a solution of Soda in the same manner 
as described under Potassa. 

Description and Properties. — Dry, white, translucent pencils 
or fused masses, showing a crystalline fracture, odorless, and 
having an acrid and caustic taste. Great caution is necessary in 



760 A TEXT-BOOK OF MA TERIA MEDICA. 

tasting and handling it, as it rapidly destroys organic tissues. 
Exposed to the air, it rapidly deliquesces, absorbs carbon dioxide, 
and becomes covered with a dry coating of carbonate. Soluble in 
1.7 parts of water, very soluble in alcohol. Soda should be kept 
in well-stoppered bottles made of hard glass. Used externally. 

Physiolog'ical Action and Therapeutics. — Potassa is one of 
the strongest and most penetrating caustics known. It possesses 
the property of abstracting water froni the tissues, neutralizing free 
acids, decomposing nitrogenous compounds, and of forming solu- 
tions of fibrin, albumin, and gelatin. 

When applied to the soft tissues it occasions severe pain, and 
produces a moist, ashen, and then black, leathery slough, which 
leaves a granulating ulcer behind it. 

When potassa is taken internally in immoderate doses it pro- 
duces all the symptoms of corrosive poisoning. Small doses, freely 
diluted, have the same action as the alkahes. 

As a caustic, potassa is used for the same purposes as the caus- 
tics previously described. 

Potassa with lime in its operation is similar to, but milder 
than, potassa. 

The action and therapeutics of soda are identical with those of 
potassa, save that soda is less depressing to the heart, muscular 
and nervous systems. It is not used so much as potassa, the 
latter preparation usually being preferred as a caustic. 

To limit the caustic action of these drugs a piece of adhesive 
plaster should be applied first, with an aperture of the size desired. 
Upon the skin exposed in the hole in the plaster the caustic is 
placed, the skin having been previously moistened. The caustic 
action may be arrested at any time by wetting the part with vinegar. 

Acidum Aceticum Glaciale— Acidi Acetici Glacialis 
—Glacial Acetic Acid. JJ, S. JP. 

Orig-in. — Prepared by distilling dry Sodium Acetate with strong 
Sulphuric Acid. 

Description and Properties. — A clear, colorless liquid, of a 
strong, vinegar-like odor, and a very pungent, purely acid taste. 
Its specific gravity at 15° C. (59° F.) should not be higher than 
1.058, corresponding to at least 99 per cent, of absolute acid. 
Used externally. 

Physiolog'ical Action and Therapeutics. — Glacial acetic acid is 
a powerful corrosive poison, having an action similar to that of the 



CAUSTICS OR ESCHAROTICS. 761 

mineral acids. The drug is principally used as a caustic for the 
removal of luarts and corns, and occasionally for blistering the skin. 

Calx— Calcis— Lime. Z, S, J*. 

Orig-in. — Obtained by burning White Marble, Oyster Shells, or 
the purest varieties of natural Calcium Carbonate. 

Description and Properties. — Hard, white or grayish-white 
masses, which, in contact with air, gradually attract moisture and 
carbon dioxide, and fall to a white powder ; odorless ; of a sharp, 
caustic taste. Soluble in about 750 parts of water; insoluble in 
alcohol. Used externally. 

Physiolog-ical Action and Therapeutics. — Quicklime when 
used undiluted is caustic, producing effects similar to those de- 
scribed under Potassa. 

For caustic purposes it is usually mixed with potassa (potassa 
cum cake). When lime is given in diluted solution, it acts as an 
astringent and antacid. (See Liquor Calcis, p. 155.) 

The conditions for which lime is employed as a caustic are men- 
tioned under Potassa. 

Zinci Chloridum— Zinci Chloridi— Zinc Chloride. 

Orig-in. — Prepared by dissolving Zinc in boiling Hydrochloric 
Acid. To the solution is added first Nitric Acid, then Zinc Car- 
bonate to precipitate the impurities. Filter and finally evaporate. 

Description and Properties. — A white, granular powder or 
porcelain-like masses, irregular or moulded into pencils ; odorless ; 
of such intensely caustic properties as to make tasting dangerous, 
unless the salt be dissolved in much water, when it has an astrin- 
gent, metallic taste. Ver}^ deliquescent ; soluble in about 0.3 part 
of water, forming a clear solution ; ver}^ soluble in alcohol. Zinc 
chloride should be kept in small, glass-stoppered bottles. 

Used externally. 

Physiolog-ical Action and Therapeutics. — Zixc chloride is 
caustic, antiseptic, disinfectant, excitant, astringent, and slightly 
hemostatic, according to the strength of the preparation. Its caus- 
tic action is painful, yet, while the drug penetrates ver}^ deeply, 
limited to the seat of application. 

Poisoning by zinc chloride is evidenced by all the symptoms 
produced by a violent corrosive irritant poison. 



762 A TEXT-BOOK OF MATERIA MEDICA. 

The drug formerly enjoyed quite a reputation as a remedy for 
cancer, especially epithelioma, in which case it was used in the 
form of " caustic arrows " inserted in the base of the growth so as 
to separate it from the healthy tissues. 

It is used as a paste and lotion for morbid growths, lupus 
exedeits, putrid tdcers, ncevi, and syphilitic sores. 

Solutions of zinc chloride are injected into polypi and scrofu- 
lous glands, and for the destruction of the pulp of decayed teeth. 

A weak solution of zinc chloride is an efficient injection in 
gonorrhea, leucorrhea, and hemorrhagic endometritis. 

For caustic purposes the zinc chloride itself may be used, or 
a paste prepared with starch, gypsum, flour, anhydrous sulphate 
of Hme, or powdered althea. Mayet's paste consists of zinc chlo- 
ride 8 parts, zinc oxide i part, dried wheat flour 7 parts, and water 
I part. The cuticle must always be removed before applying 
the paste, strong water of ammonia answering for this purpose. 

Bromum—Bromi— Bromine. TJ. S, P. 

Origin. — It is found both in sea-water and in saline springs, but 
is chiefly obtained from the mother-liquors of salt-works in the 
United States and at Strassfurth, Germany. 

Description and Properties. — A heavy, dark brownish-red, 
mobile liquid, evolving, even at ordinary temperatures, a yellowish- 
red vapor, highly irritating to the eyes and lungs, and having a 
peculiar suffocating odor, resembling that of chlorine. Soluble in 
30 parts of water and readily soluble in alcohol or ether. Bromine 
should be kept in glass-stoppered bottles, in a cool place. 

Used externally. 

Physiological Action and Therapeutics. — -Bromine is a power- 
ful corrosive irritant, the fumes of which occasion severe irritation 
of the eyes and respiratory passages, with cough, hoarseness, and 
dyspnea. When taken into the stomach it produces all the symp- 
toms of corrosive poisoning. 

The drug is an active caustic, deodorant, and disinfectant. It 
was formerly extensively employed, particularly during the Civil 
War of the United States, for the treatment of hospital gangrene, 
for which it is a most efficient remedy. Bromine has also been used 
as an injection (i part to 3 of alcohol) in various forms of ca^icer. 
Owing to the pain attending the operation, however, the treatment 
has not been generally adopted. 

Bromine is an efficient disinfectant, and has been employed to 



VESICANTS AND EPISPASTICS, 7^^ 

disinfect and deodorize the atmosphere of hospitals, etc. Berlin 
sanitary officials declare that " 3^ ounces of bromine can disinfect 
a space of 918 cubic feet, and deodorize a space of 7000 cubic feet." 



GROUP XIX.— VESICANTS AND EPISPASTICS. 

These are drugs which excite more or less local inflammation 
when applied to the skin ; the inflammatory condition is accom- 
panied by an effusion of serum between the epidermis and dermis — 
i. e. a blister. 

The principal Vesicants are — 

Acetic Acid (glacial), Mezereon, 

Ammonia (the confined vapor), Mustard (volatile oil), 

Cantharides, Rhus Toxicodendron. 
Iodine, 

There are certain drugs which affect certain parts of the skin — 
for instance, the orifices of the sudoriferous glands — in a special 
manner, and their action on these parts is such as to give rise to 
pustules rather than blisters. Drugs which affect the skin in this 
manner are called Pustulants. The following-named drugs are 
the most important of them : 

Croton Oil, Silver Nitrate, 

Tartar Emetic, Ipecac. 

Therapeutics. — Vesicants are employed as local stimulants in 
chronic ulcers and to facilitate the absorption of effusions, as in 
clironic synovitis or chronic thickening about the joints. 

Blisters are also of use in endocarditis, neuralgias, sciatica, chronic 
pericarditis, pleurisy, hysterical paralysis, and aphonia, cerebral or 
spinal meningitis, etc. 

Pustulants are more particularly employed to maintain a con- 
tinuous though moderate irritation in chronic inflammations. They 
are used for the same class of cases as vesicants, but are preferable 
when it is desirable to prolong the local irritation without exciting 
too much inflammation. 

Contraindications. — Vesicants are usually contraindicated in 
acute inflammations and in inflammation of the cutaneous tissues, 
as rubeola and scarlatina. Vesicants are not permissible in preg- 
nancy, debility, scorbutus, and purpura, or in extreme infancy and 
old age. They should not be applied over the scrotum or the 



764 A TEXT-BOOK OF MATERIA MEDICA. 

mammary glands, nor over bony prominences where the healing 
processes are apt to be retarded. 

All the vesicants and pustulants have, with two exceptions, been 
discussed elsewhere. 

Cantharis— Cantharidis— Cantharides. 77. H, jP. 

(Spanish Flies.) 

Origin. — Cantharis vesicatoria De Geer, a beetle indigenous to 
Southern and Central Europe, and found eastward as far as West- 
ern Asia. 

Description and Properties. — About i inch (25 Mm.) long and 
\ inch (6 Mm.) broad ; flattish-cylindrical, with filiform antennae, 
black in the upper part, and with long wing-cases and ample, 
membranous, transparent, brownish wings, elsewhere of a shining, 
coppery-green color. The powder is grayish-brown, and contains 
green shining particles. Odor strong and disagreeable ; taste slight, 
afterward acrid. 

Cantharides contains a fatty crystallizable body, cantharidin, 
which is the active principle, a volatile oil also possessing vesica- 
tory properties, and a green oil closely allied to chlorophyl. 

Used externally. 

Official Preparations. , 

Ceratum Cantharidis — Cerati Cantharidis — Cantharides Cerate. — Cantha- 
rides, 320; Yellow Wax, i8o; Resin, i8o; Lard, 220; Oil of Turpentine, 150. — Used 
externally. 

Collodium Cantharidatum — Collodii Cantharidati — Cantharidal Collodion 
(Blistering Collodion). — Used externally. 

Tinctura Cantharidis — Tincturse Cantharidis — Tincture of Cantharides. — 
Dose, 1-15 minims (0.06-1.0 Co.). 

The Cantharides Cerate is an ingredient of Emplastrum Picis Cantharidatum. 

Antag-onists and Incompatibles. — There are no known physi- 
ological antagonists or incompatibles. 

Synergists. — Members of this group enhance the vesicating 
action of cantharides. Its aphrodisiac action is aided by phos- 
phorus and strychnine. 

Physiological Action. — Externally and Locally. — Cantharides 
is a slow though very powerful irritant. When the drug is applied 
to the skin or mucous membrane it excites a tingling, burning pain, 
with marked redness of the cuticle. In the course of three or four 
hours after the application of cantharides there are formed numer- 



VESICANTS AND EPISPASTICS. 765 

ous vesicles which soon coalesce, forming one large bleb full of 
clear serum. 

The drug not only causes vascular dilatation of the part to 
which it is applied, but reflexly dilates the blood-vessels of the 
deep-seated organs underneath, thus acting as a counter-irritant. 

The active principle of cantharides may be absorbed through 
the skin, producing its constitutional effects. 

Internally. — Digestive System. — Moderate doses of cantharides 
produce a sensation of heat in the stomach, and may even occasion 
gastrodynia. Large amounts occasion severe gastro-intestinal irri- 
tation. There is a sense of constriction in the esophagus, a burning 
heat in the throat, ptyalism, intense gastric pain, nausea, and vomit- 
ing of glairy mucus often containing blood. There is great tender- 
ness over the abdomen, fibrinous and sometimes bloody stools, 
attended by griping pain and tenesmus. 

Circulatory System. — Full medicinal doses excite the heart, 
increasing the force and rapidity of its action, and elevate arterial 
tension. Under large doses the pulse and arterial pressure fall, 
and there is great depression of the entire circulator}^ system. 

Nervous System. — Small doses have no influence on the nervous 
system other than would be produced by stimulation of the 
circulation. Excessive amounts have produced marked cerebral 
effects, consisting of partial or general convulsions, coma, and 
insensibility. 

Respiratory System.— l^o effect follows medicinal doses ; toxic 
amounts accelerate and weaken the respiration. 

Absorption and Elimination. — The active principle of cantharides 
is rapidly absorbed into the blood, and in large doses produces 
marked irritation of the genito-urinary organs. There is at first 
increase of urine, which is soon greatly diminished in amount, and 
which may be albuminous or bloody. There is strangury and fre- 
quent desire to micturate, and severe pain in the loins and bladder. 
The local irritation is apt to occasion priapism, with frequently 
erotic excitement and seminal emissions. There may also be 
swelling and inflammation of the external genitals. In women 
cantharides may also occasion increased sexual desire, cause abor- 
tion, or induce menstruation. Yet amatory desire does not always 
follow the ingestion of cantharides, even in large doses. Indeed, 
the aphrodisiac effect of the drug is usually more manifest under 
small or full medicinal doses than from the ingestion of immoderate 
amounts. The drug is principally ehminated by the kidneys. 



766 A TEXT-BOOK OF MATERIA MEDIC A. 

Temperature. — The temperature is at first elevated by excessive 
amounts, but declines together with the depression of the circu- 
latory system. 

Uterus. — The uterus and female genital organs are stimulated by 
the drug, as has been previously described. 

Untoward Action. — The untoward manifestations do not differ 
from the symptoms produced by excessive amounts, as described 
under the different systems. These various untov/ard effects vary 
in intensity according to the individuality of the patient. 

Poisoning. — Toxic amounts of cantharides produce violent gastro- 
intestinal and genito-urinary inflammation. The general symptoms 
are great pain in the throat, stomach, and bowels, excessive thirst, 
vomiting of bloody mucus, frequent stools which may contain blood, 
burning pain in the kidneys, strangury, scanty, albuminous, and 
bloody urine, painful erections of the penis, seminal emissions, swell- 
ing and inflammation of the external genitals, a rapid, small, and 
weak pulse, accelerated respiration, skin hot and dry, congestion of 
the face, pain in the head, delirium, trembling, partial or general 
convulsions, and coma. The post-mortem appearances are swell- 
ing, ecchymoses, and sometimes gangrene of the mucous mem- 
brane of the ahmentary canal. The kidneys are enlarged and 
engorged, and are in a condition of parenchymatous and desquam- 
ative nephritis. 

Treatment of Poisoning. — The stomach should be emptied, and 
demulcents, stimulants, and opiates given as necessary. Oils and 
fats should be avoided, as they increase the solubility and favor the 
absorption of cantharidin. 

Therapeutics. — Externally and Locally. — A cantharidal blis- 
ter is frequently of service as a revulsive when there is a local tend- 
ency to congestion. The drug is applied to the chest in the second 
stage of pneumonia and in pleurisy, and '' flying " blisters are 
beneficial in hydrothorax and chronic pleurisy. 

The cure of boils and carbuncles has been hastened by applying 
a cantharidal blister to the indurated spot. 

The drug is also of service to stimulate indolent ulcers, fistidce, 
etc. 

A blister over the region of the heart will often afford marked 
relief in pericarditis. 

A CANTHARIDAL PLASTER applied ovcr the course of the affected 
nerve frequently ' affords great relief from pain in neuralgia and 
some forms of sciatica. 



VESICANTS AND EPISPASTICS. 767 

In certain diseases of the brain and spinal cord blisters applied 
to the nape of the neck or along the course of the cord, a little to 
one side of the vertebrae, will often favorably influence the course 
of the disease. 

Blisters are frequently of service in synovitis and periostitis of 
the larger bones. A bhster apphed to the epigastrium will some- 
times allay gastric pain and obstinate vomiting. 

Blistering over the region of the ovary is an efficient means of 
relieving the symptoms of cliro^iic ovaritis, and a blister applied to 
the mastoid region will frequently be of benefit in otitis media. 

Small patches of tinea tonsurans and of tinea circinata may be 
removed by blistering. 

Liniments and lotions containing tincture of cantharides are 
among the best means of curing alopecia. 

The National Dispensatory aptly gives the general uses for 
cantharides in the form of blisters as follows: " i, to stimulate 
the whole or a particular part of the system ; 2, to promote the 
absorption or prevent the accumulation of inflammatory exuda- 
tions ; 3, to recall suppressed discharges ; 4, to act as a depletory ; 
5, to promote the cure of internal diseases by counter-irritation of 
the skin." 

Internally. — Certain diseases of the genito-urinary organs, as 
debility of the bladder with accompanying incontinence of urine, 
chronic pyelitis, chronic catarrJi of the bladder, etc., are benefited 
by small doses of tincture of cantharides. 

Small doses of this preparation are sometimes serviceable in the 
treatment of acute desquamative nephritis. Diabetes insipidus has 
been arrested by the internal administration of cantharides. 

Gleet, prostatorrhea, and spermatorrhea are benefited by this 
drug. MeJtorrhagia and amenorrhea occurring in debilitated women 
will often be benefited by cantharides. 

Tincture of cantharides, with tincture of iron, tincture of nux 
vomica, and phosphoric acid, is an efficient combination in impo- 
tence, the result of old age, sexual excesses, or masturbation. 

In scaly skin diseases cantharide^ often proves very serviceable 
after arsenic and the external application of tarry preparations have 
failed. 

Cantharidin and potassium cantharidate have been recom- 
mended by Professor Liebreich as efficient remedies in tuberctdosis. 

Hypodermic injections not exceeding y^ grain (0.0006 Gm.) of 
cantharidin are used, and in some cases apparently have been 



768 A TEXT-BOOK OF MATERIA MEDICA. 

followed by good results. The treatment, however, has not proved 
sufficiently successful to warrant its employment to the exclusion 
of other measures. 

Administration. — A cantharidal blister should not be allowed 
to remain on the skin for more than twelve or twenty-four hours, 
six to eight hours usually being sufficient. 

When blebs are formed, they should be carefully opened at 
their most dependent parts. When the serum has drained away 
the part should be dressed with a layer of borated cotton kept in 
place by the aid of a few strips of adhesive plaster. Should the 
blistering by cantharides occasion too great pain, a poultice made 
of breadcrumb and solution of subacetate of lead, to which is 
added \ ox \ grain (0.008 or 0.0 1 Gm.) of morphine sulphate or 
other soothing appHcation, should be applied to the blistered part. 
The obstinate ulcers which sometimes follow the use of cantharides 
blisters may be treated effectively by Goulard's cerate. 

It is said that the strangury which plasters of cantharides fre- 
quently cause may be prevented by sprinkling the surface of the 
plaster with powdered camphor or sodium bicarbonate. 

For internal use the tincture of cantharides is the only prepara- 
tion to employ. 

Sinapis Alba— Sinapis Albae— White Mustard. 

V. S. I". 

Origin. — The seed of Brasstca alba L., Hooker filius et Thomp- 
son. 

Sinapis Nigra— Sinapis NTgrae- Black Mustard. 

Z7. >S. J». 

Orig-in. — The seed of Brassica nigj^a L., Koch. 

Both the white and black mustard are annual plants, indigenous 
in Southern Europe and Western Asia, cultivated, and sometimes 
found wild, in the United States. 

Description and Properties. — White mustard seeds are 
almost globular, about -^^ inch (2 Mm.) in diameter, with a circular 
hilum ; testa yellowish, finely pitted, hard ; embryo oily, with a 
curved radicle and two cotyledons, one folded over the other ; free 
from starch ; inodorous ; taste pungent and acrid. 

Black mustard seeds resemble the preceding in shape, but have 
a diameter only of -^-^ inch (i Mm.); blackish-brown or deep red- 



VESICANTS AND EPISPASTICS. 769 

dish-brown, with a testa covered with shallow pits, and when 
crushed and macerated with water acquiring a strong and pungent 
odor. 

White mustard seed contains an almost tasteless, yellowish, 
fixed oil, and a substance known as sinalbin, which is the chief con- 
stituent. This substance may be converted into allyl sulphocyanide 
(a volatile oil) by the action of the ferment myj^osin and water. 
Black mustard seeds contain the same fixed oil as the white mus- 
tard, and a glucosid, sinigrin, which by the action upon it of myro- 
sin in contact with water converts it into sulphocyanate of aadjtyl 
(the volatile oil of mustard). To this volatile oil of mustard, which 
is official, is due both the pungent taste and odor of the moistened 
powder. 

Dose. — 1-4 drachms (4.0-15.0 Gm.). 

Official Preparation (of Black Mustard Seed). 
Charta Sinapis — Chartae Sinapis — Mustard Paper. 

Oleum Sinapis Volatile— Olei Sinapis Volatilis— Vol- 
atile Oil of Mustard. U. S. J>. 

. Origin. — A volatile oil obtained from Black Mustard by macera- 
tion with Water and subsequent distillation. 

Description and Properties. — A colorless or pale yellow, limpid, 
and strongly refractive liquid, having a very pungent and acrid odor 
and taste. Freely soluble in alcohol, ether, or carbon disulphide. 
Used externally. 

Official Preparation. 
LinimSntum Sinapis Compositum — Linimgnti Sinapis Comp6siti — Com- 
pound Liniment of Mustard. — Formula: Volatile Oil of Mustard, 30; Fluid Ex- 
tract of Mezereum, 200; Camphor, 60; Castor Oil, 150; Alcohol, to 1000, by solution. 
Used externally. 

Physiological Action. — Externally and Locally. — Mustard is 
irritant, counter-irritant, rubefacient, and vesicant. Any degree of 
irritation, from slight redness of the skin to severe blistering, may 
be produced by mustard. It is more rapid in its action than can- 
tharides, and when applied to the skin there is produced almost 
immediately a sensation of warmth, which rapidly passes into a 
severe burning pain. This irritation of the sensory nerves is suc- 
ceeded by paralysis and more or less loss of sensation, so that if 
mustard be allowed to remain on the skin until blistering ensues 
there is a decided diminution of pain. 

49 



^'JO A TEXT-BOOK OF MATERIA MEDICA. 

The local application of mustard reflexly stimulates the heart 
and respiration. 

Internally. — Mustard in small amounts is taken as a condiment, 
and is a powerful stimulant of the gastro-intestinal tract. Large 
doses irritate the stomach and act as an emetic, producing prompt 
emesis without depression, owing to the reflex stimulation of the 
heart and respiration. 

The volatile oil of mustard is never intentionally given inter- 
nally. It is a powerful caustic irritant, a single drop upon the 
tongue producing an intense burning pain in the throat, stomach, 
and nose. 

Therapeutics. — Externally and Locally. — Mustard may be used 
locally for the same purposes as cantharides, being superior to the 
latter-named drug when a simple rubefacient effect is desired. 
Mustard when applied locally is more of a stimulant to the circu- 
latory and respiratory systems than cantharides, and is therefore an 
efficient remedy in syncope, asphyxia, and coma. 

As a stimulant in these conditions, a large mustard poultice is 
applied to the legs. 

A MUSTARD BATH, in the strength of i drachm (4.0 Gm.) to i 
gallon (3785.43 Cc.) of water, is an efficient means of breaking up 
a cold, and if properly used is of service when the rash in measles 
or scarlet fever has receded. 

The menses may often be re-established when suppressed by a 
MUSTARD siTZ-BATH, taken at the time of the expected period. 

Internally. — Other than the use of mustard as a condiment, the 
drug is given only to produce vomiting, being one of the best 
emetics in indigestion and narcotic poisonijig. 

Obstinate hiccough has sometimes been arrested by an infusion 
OF mustard. 

Administration. — A mustard plaster, or sinapism, is prepared 
by mixing equal parts of wheaten or rye flour with water to the 
consistence of a thick paste, which is spread on linen or cotton 
cloth and applied to the skin. A dampened piece of gauze inter- 
posed between the plaster and the skin will prevent the former 
from adhering. 

A mustard cataplasm is a weaker preparation. A flaxseed or . 
cornmeal poultice is made, to which a small quantity of ground 
mustard is added. This is intended to maintain a gentler but more 
prolonged action than the sinapism. 

" Mustard leaves," or plasters which may be obtained ready pre- 



RUBEFACIENTS. 77^ 

pared at drug-stores, are intended to be simply dipped in water and 
applied to the skin. Their activity may be lessened by interposing 
a thin piece of linen or cotton cloth between the plaster and the 
skin. 

Liniments containing oil of mustard are efficient rubefacients, 
care being taken to adapt the strength of the preparation to the 
delicacy of the skin. 

When mustard is taken as an emetic, it is given in the form of 
an infusion, in the proportion of i, 2, or 3 drachms (4.0, 8.0, or 
12.0 Gm.) to I pint (473.17 Cc.) of water. 

A preparation known as mustard whey is sometimes given. It 
is prepared by boiling ij ounces (46.65 Gm.) of bruised mustard 
seed in a mixture of I pint (473.17 Cc.) of milk and i quart (946.35 
Cc.) of water, until it is curdled, when the whey should be 
strained off. 



GROUP XX.— RUBEFACIENTS. 

These are drugs which, when locally applied, are intended to 
produce temporary redness and congestion of the skin. Some 
of them are vesicant if applied in full strength, and if their contact 
with the skin be sufficiently prolonged, vesication, or even total 
destruction of tissue, may result. 

The following hst embraces the principal rubefacient drugs : 

Ammonia, Menthol, 

Alcohol, Mezereon, 

Arnica, Mustard, 

Camphor, Oil of Cajuput, 

Capsicum, Oil of Turpentine, 

Chloroform, Pitch, 

Ether, Volatile Oils. 
Iodine, 
Hot water and friction are also rubefacient agents. 

Rubefacients are used for their influence upon the skin itself 
or for their effect on deep-seated structures. 

Rubefacients are efficient means of relieving neuralgic pains, 
conditions of nervous debility, nervous excitement, the sense of 
fatigue, and as an aid in narcotic poisoning, also to hasten the 
absorption of inflammatory exudates, to remove the swelling and 
restore the function of chroitically inflamed joints, etc. 



772 A TEXT-BOOK OF MATERIA MEDIC A. 

Rubefacients should ordinarily be applied with friction, as rub- 
bing of the skin aids the action of many of them. 

Save one, all the rubefacients mentioned in the preceding list 
have been considered elsewhere in the present work. 

Pix Burgundica— Picis Burgundicae— Burgundy 
Pitch. JJ.S.J^. 

Orig-in. — The prepared resinous preparation of Abies excelsa 
Poiret, the spruce fir, or Norway spruce, a stately tree growing 
in Northern Asia and Northern Europe, and frequently cultivated 
in the United States. 

Description and Properties. — Hard, yet gradually taking the 
form of the vessel in which it is kept, brittle, with a shining, con- 
choidal fracture, opaque or translucent, reddish-brown or yellowish- 
brown ; odor agreeably terebinthinate ; taste aromatic, sweetish, 
not bitter. It is almost entirely soluble in glacial acetic acid or in 
boiling alcohol, and partly soluble in cold alcohol. 

Burgundy pitch contains a resin and a volatile oil in variable 
proportion. 

Used externally. 

Official Preparations. 

Empiastrum Picis Burgtindicae — Empiastri Picis Burgiindicae — Burgundy- 
Pitch Plaster. — Contains 90 per cent, of Burgundy Pitch. ■ Used externally. 

EmplSstrum Picis Cantharidatum — EmplSstri Picis Cantharidati — Can- 
tharidal Pitch Plaster (Warming Plaster). — Contains 8 per cent, of Cerate of 
Cantharides. Used externally. 

Burgundy Pitch is contained in EmplSstrutn FSrri and Empiastrum Opii. 

Physiolog-ical Action and Therapeutics. — Burgundy pitch 
when applied to the skin in the form of a plaster occasions red- 
ness and a papular eruption, accompanied by itching. If the plaster 
is allowed to remain in contact with a delicate skin for too long 
a period, there may be produced a vesicular or even pustular 
eruption. 

The chief uses of Burgundy pitch plaster are to protect, sustain, 
or stimulate the part to which it is applied. 

The plaster is an efficient remedy in subacute and chronic 
pleurisy, chronic bronchitis, lumbago, muscular rheumatism, etc. 

Before applying a Burgundy pitch plaster to a hairy skin, the 
hair should be shaved off. The removal of the plaster may be 
facilitated by warming it, applying to the back of the plaster 
a hot bottle or hot water-bag. Any particles of pitch which may 



EMOLLIENTS, DEMULCENTS, ETC. 



77Z 



adhere to the surface of the skin may be removed by washing 
with warm alcohol. 



GROUP XXI. 



-EMOLLIENTS, DEMULCENTS, AND 
PROTECTIVE AGENTS. 



Emollients are substances which soften, relax, and protect the 
tissues to which they are applied They reheve pain and tension 
by diminishing heat and lessening the pressure, on the nerves. 

The principal emoUients are — 
Glycerin, 



Soap Liniment, 
Starch, 



Fats and Oils, 



Lard, 
Olive Oil, 
Almond Oil, 
Spermaceti, 
Linseed Oil, 
Cacao Butter, 
Petroleum, 
Paraffin, 
Petrolatum, 
Vaseline, etc. 



Hot Fomentations, 



Poultices, 



Linseed Meal, 
Oatmeal, 
Bran, 
Bread, 
Flour, 
Figs, etc. 

Demulcents are substances which soothe and protect the parts 
to which they are appHed. They are generally of a mucilaginous 
nature, and are employed for their action upon mucous membranes, 
while emollients are principally used on the skin. The important 
demulcents are — 

Acacia, Marshmallow, Sassafras-pith, 

Barley, Liquorice, Isinglass, 

Cetraria, Starch, Honey, 

Almond, Tragacanth, Gelatin, 

Flaxseed, Glycerin, Bland Oils. 

Slippery Elm, White of Egg, 



774 A TEXT-BOOK OF MATERIA MEDIC A. 

Both Emollients and Demulcents are exceedingly useful agents 
to relieve irritation of the skin in certain cutaneous diseases ; by 
softening the skin and mucous membranes they also prevent crack- 
ing or chapping from exposure to cold. They are also efficient 
agents to prevent bed-sores and to lessen friction between approx- 
imating surfaces, as between the nates and about the groins of 
children. 

Demulcents are employed internally with good results when 
there is an irritated or inflamed condition of mucous membranes^ 
whether of the respiratory, gastro- intestinal or genito-urinary tracts, 
as in bronchitis^ gastritis, enteritis, diarrhea, dysentery, strangury, 
cystitis, etc. 

Demulcents — such as flaxseed, slippery elm, marshmallow, 
or SASSAFRAS-PITH — are very agreeable and efficient agents to quench 
thirst and to relieve the irritation of mucous surfaces in febrile 
affections. 

Protectives are agents used to mechanically cover and protect 
injured or diseased surfaces from extraneous influences, as from 
air, water, etc. 

Certain agents classed as protectives are employed for their 
absorptive power of taking up by capillary attraction any moisture 
or fluid present. 

They are useful agents as protective coatings to bed-sores or to 
excoriated, abraded, or burned surfaces. 
The principal protectives are — 
Collodion, 

Solution of Gutta-percha, 
Solution of Sodium Silicate, 
Court-plaster (Emplastrum Ichthyocollae), 
Lycopodium, 
Charcoal, 
Animal Charcoal, 
Purified Cotton. 
The EmolHents, Demulcents, and Protectives which are deemed 
sufficiently important to merit more consideration than has been 
given them elsewhere in the present work, will be now considered. 

Glycerinum—GIycerlni— Glycerin. JJ. S. JP. 

Origin. — A liquid obtained by the decomposition of vegetable 
or animal fats or fixed oils, and containing not less than 95 per 
cent, of absolute glycerin. 



EMOLLIENTS, DEMULCENTS, ETC. 775 

Description and Properties. — A clear, colorless liquid, of a 
thick, syrupy consistence, oily to the touch, odorless, very sweet 
and slightly warm to the taste. When exposed to the air, it 
slowly abstracts moisture. Specific gravity not less than 1.250. 
Soluble in all proportions in water or alcohol ; also soluble in a 
mixture of 3 parts of alcohol and i part of ether, but insoluble 
in ether, chloroform, carbon disulphide, benzin, benzol, and fixed 
or volatile oils. 

Dose. — 5-60 minims (0.3-4.0 Cc). 

Official Preparations. 

Glyceritum Amyli — Glyceriti Amyli — Glycerite of Starch. — Starch, 10; Water, 
10; Glycerin, 80. Used internally or externally. 

Glyceritum VitSlli— Glyceriti VitSUi— Glycerite of Yolk of Egg (Glyco- 

NIN). — Fresh Yolk of Egg, 45 ; Glycerin, 55. Used freely internally or externally. 

Suppositoria Glycerini — Suppositoria (ace.) Glycerini — Suppositories of 
Glycerin, — (Each suppository contains 93 grains (6,0 Gm.) of glycerin.) Used as re- 
quired. 

Glycerin is also contained in the following official preparations : 

Glyceritum Acidi Carbolici, Glyceritum Acidi Tannici, Glyceritum Boro- 
glycerini, Glyceritum Hydrastis, Mucilago Tragacanthse, M^ssa Hydrargyri 
Pilulae Phosphori, and in many extracts and fluid extracts. 

Antagonists and Incompatibles. — Glycerin is incompatible 
with potassium permanganate and with chromic acid. 

Synergists. — Its emollient properties may be enhanced by 
emollients and demulcents. 

Physiological Action. — Externally and Locally. — When gly- 
cerin is applied to the skin or mucous membrane it is ordinarily 
bland and unirritating, although in certain cases the drug occasions 
a sensation of burning and smarting, which may be due either to 
an impure preparation, the rapid absorption of water from the 
tissues, or merely to a marked idiosyncrasy on the part of the 
patient. Should the pure drug show a tendency to irritate the 
skin, the glycerin should be properly diluted with water. 

Preparations more concentrated than the specific gravity recom- 
mended by the U. S. Pharmacopoeia — viz. 1.25 — should be avoided, 
because of their irritating properties. 

Glycerin abstracts water from the tissues, and is rapidly absorbed 
through the skin. It possesses marked diffusive power, being 
capable of diffusing itself freely over and through organic matter. 

Internally. — The principal action of glycerin when taken inter- 



776 A TEXT-BOOK OF MA TERIA MEDICA. 

nally is that of a purgative. The drug purges when given by the 
rectum, either as enema or in the form of a suppository. 

Glycerin is readily absorbed from the alimentary canal, and it 
is thought by some physicians to undergo oxidation, thereby act- 
ing as a food and increasing body-weight. Other competent inves- 
tigators allege that it is not in the least degree nutritious. 

When immoderate amounts of the drug are taken, it may be 
detected in the urine, while under -excessive doses effects may be 
produced similar to those resulting from alcoholic poisoning. 

Following the ingestion of very large doses, there may be 
extreme muscular weakness, dryness of mucous membranes, dark- 
colored urine, collapse, and death. The drug is not considered 
poisonous, excessive amounts being necessary to produce the 
symptoms above described. 

Therapeutics. — Externally and Locally. — Glycerin is a popular 
and efficient remedy for chapped hands and slight excoriations. 

Fissured nipples and fissure of the anus are well treated with 
pure GLYCERIN or with glycerin and tannic acid. The drug also 
makes an efficient application to bed-sores. 

Glycerin is employed as an injection in gonorrhea. It may be 
used alone or medicated with bismuth subnitrate or with extract 
of opium. 

Glycerin is one of the best solvents for hardened cerumen^ and 
tampons wet with glycerin or with glycerite of tannic acid are 
very serviceable in leiicori'hea and erosion of the cervix, and endo- 
metritis with congestion and subinvolution of the uterus. 

Glycerin possesses marked antipruritic properties, and, whether 
applied pure or combined with oils or ointments, will allay itching 
of most affections of the skin. 

Lotions or diluted aqueous solutions of glycerin are fre- 
quently employed in various diseases of the ear, nose, and throat, 
such d.s fissure of the tongue, chronic laryngitis, chronic nasal catarrh, 
coryza, pharyiigitis, etc. 

A mixture of glycerin and water will lessen or prevent dry- 
ness of the mouth from fever or other causes. 

Glycerin is an efficient topical remedy for the reduction of 
edema of the prepuce, and is a serviceable antiseptic dressing for 
wounds, carbuncles, boils, etc. 

Glycerite of starch is an excellent soothing emollient in 
acute eczema, and quite an efficient preparation to prevent pitting in 
vaviola. 



EMOLLIENTS, DEMULCENTS, ETC. J-JJ 

Glyconin (glycerite of yolk of Qgg) makes an agreeable, sooth- 
ing application in erysipelas, fissured nipples, etc. 

Ijiternally. — The principal internal use for glycerin is for the 
relief of habitual constipation, being far more efficient in habitual 
than in occasional constipation, and more generally applicable to 
females than to males, and to those cases where the fecal mass is 
retained in the rectum than in the sigmoid flexure or above it. 
For the purpose of relieving constipation it may be given by the 
mouth, alone or associated with castor oil, or i or 2 fluidrachms 
{4.0-8.0 Cc.) injected into the rectum, or, which perhaps is the 
most agreeable method, by the insertion into the rectum of a 

•GLYCERIN SUPPOSITORY. 

Glycerin is said to relieve the acidity, pyrosis, and flatulence of 
dyspepsia. 

It has been employed in diabetes, but without favorable results. 

Administration. — Whether glycerin be used externally or in- 
ternally, it should always be chemically pure, otherwise much irri- 
tation may be produced. 

For external use it may be used pure or mixed with water, or 
in various lotions, ointments, etc. 

Internally it is seldom given alone, but with syrups, water, 
wine, or other alcoholic liquors. 

Oleum OlTvae— Olei Ollvae— Olive Oil. TI.S.JP, 

Origin. — The fixed oil expressed from the fruit of Olea Europcea 
L., a shrubby, thorny, medium-sized tree, indigenous in Western 
Asia, but cultivated in the countries bordering on the Mediter- 
ranean and in the Southern United States, California, and several 
South American and other countries. 

Description and Properties. — A pale yellow or light greenish- 
yellow, oily liquid, having a slight, peculiar odor, and a nutty, 
oleaginous taste, with a faintly acrid after-taste. Very sparingly 
soluble in alcohol, but readily soluble in ether, chloroform, or car- 
bon disulphide. Olive oil should be kept in well-stoppered bottles 
in a cool place. 

Dose. — Freely. 

Physiological Action and Therapeutics. — Olive oil is a singu- 
larly bland and agreeable oil, and very useful as an emollient and 
demulcent. It serves as an efficient protective to the skin, from 
which it is readily absorbed. As a lenitive and protective in cases 



'JjS A TEXT-BOOK OF MATERIA MEDICA. 

of superficial wounds, bruises, excoriations, burns, bites and stings of 
insects, sprains, etc. it serves a valuable purpose. 

It is extensively employed by dermatologists to soften and facili- 
tate the removal of crusts, scales, and epithelial debris of various 
cutaneous disorders. 

The application of warm olive oil, made with gentle friction to 
painful and engorged rnaminary glands during pregnancy and after 
parturition, generally lessens the pain and swelling. 

The drug is an efficient palliative in painfid deglutition, and is 
sometimes injected into the rectum as a soothing emollient in dys- 
entery, and to destroy " seat-worms " and allay the irritation pro- 
duced by them. 

Frequently the forcible injection into the urethra of olive oil 
will dilate an unusually tight stricture, partly overcoming the dif- 
ficulty to the introduction of a sound. 

Olive oil is habitually employed as a lubricant for sounds, cathe- 
ters, specula, pessaries, etc. 

Where a fat or an oil is not contraindicated, olive oil is one of 
the most efficient demulcents to administer in cases of poisoning 
from corrosive irritating drugs. 

Olive oil is a useful and pleasant laxative, and is used to a con- 
siderable extent for that purpose. The oil is also credited with 
facilitating the discharge oi gall-stones. It unquestionably increases 
the secretion of bile, which may account for its apparent influence 
in favoring the expulsion of these concretions. 

Oleum Amygrdalae Expressum— Olei Amygdalae Ex- 
press!— Expressed Oil of Almond. JJ, S. JP. 

Origin. — A fixed oil expressed from Bitter or Sweet Almond 
{Prunus Amygdalus, var. amara and dulcis, De CandoUe), a tree 15 
to 20 feet (5 to 6 M.) high, indigenous in Western Asia and culti- 
vated in subtropical countries. 

Description and Properties. — A clear, pale straw-colored or 
colorless, oily hquid, almost inodorous, and having a mild, nutty 
taste. Only sHghtly soluble in alcohol ; soluble in ether, and in 
chloroform in all proportions. It should be kept in well-stoppered 
bottles, in a cool place. 

Dose. — 1-4 fluidrachms (4.0-8.0 Cc). 

Expressed Oil of Almond is contained in Unguentum Aquae 
Rosse. 

Physiological Action and Therapeutics. — The expressed oil 



EMOLLIENTS, DEMULCENTS, ETC. 779 

of almond is a peculiarly bland and agreeably efficient demulcent 
and emollient, being used both externally and internally for the 
same purposes as olive oil. 

Oleum LIni— Olei Lini— Linseed Oil. TJ.S,!^, 

(Oil of Flaxseed.) 

Origin. — A fixed oil expressed without heat from the seed of 
Linum Usitatissimum L. 

Description and Properties. — A yellowish or yellow, oily liquid, 
having a slight, peculiar odor, and a bland taste. When exposed 
to the air it gradually thickens and acquires a strong odor and 
taste ; and if spread in a thin layer on a glass plate, and allowed to 
stand in a warm place, it is gradually converted into a hard, trans- 
parent, resin-like mass. Soluble in about 10 parts of absolute alco- 
hol, and, in all proportions, in ether, chloroform, benzin, carbon 
disulphide, or oil of turpentine. Linseed oil should be kept in 
well-stoppered bottles. 

Dose. — J-2 fluidounces (15.0-60.0 Cc). 

Physiological Action and Therapeutics. — The action and uses 
of flaxseed oil are similar to those of olive oil. One of its most 
important uses, when mixed with an equal quantity of lime water, 
is in the treatment of burns. 

The linseed itself is used extensively as a domestic demulcent 
in the form of a tea, for cough, etc., while the ground linseed makes 
an excellent poultice for all deep-seated inflammations. 

Acacia— Acaciae— Acacia. JJ. S. J^. 

(Gum Arabic.) 

Origin. — A gummy exudation from Acacia Senegal Willdenow, 
a small tree about 20 feet (6 M.) high, found in India and Africa, 
especially in the district of Khartoum, westward to Senegambia. 

Description and Properties. — In roundish tears of various 
sizes, or broken into angular fragments, with a glass-like, some- 
tinies iridescent fracture, opaque from numerous fissures, but trans- 
parent and nearly colorless in thin pieces ; nearly inodorous, taste 
insipid, mucilaginous ; insoluble in alcohol, but soluble in water, 
forming a thick mucilaginous liquid. Acacia should be slowly but 
completely soluble in 2 parts of water. 

Official Preparations. 
Mucilago AcSciae— MucilSginis AcSciae — Mucilage of Acacia (34 per cent.). 
— Dose, freely. 



780 A TEXT-BOOK OF MATERIA MEDIC A. 

Syrupus Acaciae— Syrupi AcSciae— Syrup of Acacia.— Z>c?j^, freely. 
Acacia is contained in Emulsum Amygdalae, Pulvis Cretae Compositus, and 
in some trochisci. 

Physiolog-ical Action and Therapeutics. — Acacia is a valuable 
demulcent, and gum water is in ordinary use to serve as a protective 
to inflamed and irritated mucous membranes of the respiratory, 
alimentary, and genito-urinary tracts, as in cases of pharyngitis^ 
laryrigitis, dysentery, gastritis, typhoid fever, and in febrile affections 
generally. The mucilage of acacia is sometimes used as a pro- 
tective for superficial burns, excoriations, etc. 



Cetraria— Cetrariae— Cetraria. 77. H. J*. 

(Iceland Moss.) 

Origin. — Cetraria Islandica L., fronds of a lichen indigenous in 
the Northern Hemisphere. 

Description and Properties. — From 2 to 4 inches (5 to 10 Cm.) 
long, foliaceous, irregularly branched into fringed and channelled 
lobes, brownish above, whitish beneath, and marked with small, 
depressed spots ; brittle and inodorous ; when softened in water, 
cartilaginous, and having a slight odor ; its taste is mucilaginous 
and bitter. 

Official Preparation. 

DecSctum Cetrariae — Dec6cti Cetrariae — Decoction of Cetraria. 

Physiological Action and Therapeutics. — Cetraria is a demul- 
cent and tonic, and may be used for the same purposes as acacia. 
It is, however, more nutritious than acacia, and is used to a con- 
siderable extent for chronic pulmonary affections. 

Olmus-UImi-Elm. V.H.V. 

(Slippery Elm.) 

Origin. — The inner bark of Ubmis fulva Michaux, a medium- 
sized tree, from 30 to 60 feet (9 to 18 M.) high, found in the 
United States and Canada. 

Description and Properties. — In flat pieces, varying in length 
and width, about \ inch (3 Mm.) thick, tough, pale brownish-white, 
the inner surface finely ridged ; fracture fibrous and mealy ; the 
transverse section delicately checkered ; odor sHght, peculiar ; taste 
mucilaginous, insipid. 



EMOLLIENTS, DEMULCENTS, ETC. 781 

Official Preparation. 
Mucilago Ulmi — Muciiaginis Ulmi — Mucilage of Elm. — Dose, freely. 

Physiological Action and Therapeutics. — Elm is a decided 
demulcent and possesses nutritive properties. It is pleasant to the 
taste and does not readily disturb the stomach. It is principally 
used as a demulcent in diseases of the gastro-intestinal and genito- 
urinary tracts, as diarrhea, dysejitery, cystitis, iirethritis, etc. The 
fibrous bark is moulded into tents used to dilate the neck of the 
uterus, fistulous openings, etc. 

Althaea— Althseae— Althaea. 77. >S^. J>. 

(Marsh MALLOW.) 

Origin. — The root of AltlicEa officinalis L., a perennial herb in- 
digenous in the temperate portion of Northern and Western Asia 
and in the greater part of Europe. 

Description and Properties. — In cylindrical or somewhat con- 
ical pieces, from 4 to 6 inches (10 to 15 Cm.) long, about \ inch 
(12.7 Mm.) thick, deeply wrinkled, deprived of the brown corky 
layer and small roots ; externally white, marked with a number 
of circular spots, and of a somewhat hairy appearance from the 
loosened bast-fibres ; internally whitish and fleshy. It breaks with 
a short, granular, and mealy fracture, and has a faint, aromatic odor 
and a sweetish, mucilaginous taste. It contains asparagin, muci- 
lage, sugar, and pectin. 

Official Preparation. 
Syrupus Althiiae — Sj^upi Althieae. — Syrup of Althaea. — Dose, freely. 

Physiological Action and Therapeutics. — Marshmallow is 
emollient, demulcent, and protective, and is an efficient protective 
and emollient in irritable and inflamed conditions of the skin, and 
a highly efficacious demulcent in all inflammatory and irritable 
conditions of the respiratory, digestive, and urinary organs. 

Tragacantha— Tragacanthae— Tragacanth. 17. S* JR. 

Origin. — A gummy exudation from Astragalus gunimifer Labil- 
lardiere, and from, other species of Astragalus, low shrubs, indige- 
nous in a portion of the territor\^ lying between Eastern Persia and 
Greece. 

Description and Properties. — In narrow or broad bands, more 
or less cur\'ed or contorted, marked by parallel lines or ridges, 
white or faintly yellowish, translucent, horn-like, and tough. It 



782 A TEXT-BOOK OF MATERIA MEDICA. 

contains 33 per cent, of a gum, bassorin, which is only slightly- 
soluble in water. 

Official Preparation. 

Mucilago Tragac^nthae — Muciiaginis Tragac^nthae — Mucilage of Traga- 
canth. — Dose, freely. 

Physiological Action and Therapeutics. — Tragacanth is de- 
mulcent and nutritious, and may be used for the same purposes 
as acacia, Iceland moss, etc. The mucilage of tragacanth is sin- 
gularly efficacious as a soothing emollient in chapped hands and 
irritable conditions of the skin. 

Sassafras Medulla— Sassafras Medullae— Sassafras 

Pith. V.H.l^. 

Origin. — The pith of Sassafras variifolium (Salisbury) O. 
Kuntze, a tree indigenous in North America. 

Description and Properties. — In slender, cylindrical pieces, 
often curved or coiled, light, spongy, white, inodorous, and insipid. 
Macerated in water, it forms a mucilaginous liquid, which is not 
precipitated by the addition of alcohol. 

Official Preparation. 

Mucilago sassafras Medtillae — Muciiaginis Sassafras Medtillse — Mucilage 
of Sassafras Pith. — Dose, freely. 

Physiological Action and Therapeutics. — Mucilage of Sassa- 
fras Pith is an agreeable demulcent and a mild local stimulant, and 
may be used for the same purposes as slippery elm, tragacanth, 
acacia, etc. It forms a pleasant vehicle for more active remedies. 

Ichthyocolla—Ichthyocoliae— Isinglass. TJ, S, JP. 

Origin. — The swimming-bladder of Acipenser Huso L. and of 
other species of Acipenser. 

Description and Properties. — In separate sheets, sometimes 
rolled, of a horny or pearly appearance ; whitish or yellowish, 
semi-transparent, iridescent, inodorous, insipid ; almost entirely 
soluble in boiling water and in boiling alcohol. A solution of 
isinglass in 24 parts of boiling water forms, on cooling, a trans- 
parent jelly. 

Dose. — Freely. 



EMOLLIENTS, DEMULCENTS, ETC. 783 

Official Preparation. 

Empiastrum IchthyocSllae — Empl^stri IchthyocSllae — Isinglass Plaster — 

(Court Plaster). 

Physiological Action and Therapeutics. — Isinglass is emol- 
lient, demulcent, and protective, and possesses nutritive properties. 
Isinglass plaster is commonly employed to protect abraded sur- 
faces and slight cuts of the skin. It should be moistened with 
pure water and never with saliva. 

Lycop5dium— Lycopodii— Lycopodium. 77. H*T, 

Origin. — The spores of Lycopodium clavatiim L. and of other 
species of Lycopodium, low-creeping perennials found in dry 
woods distributed over the greater portion of the globe. 

Description and Properties. — A fine powder, pale yellowish, 
very mobile, inodorous, tasteless, floating upon water and not 
wetted by it, but sinking on being boiled with it, and burning 
quickly when thrown into a flame. Under the microscope the 
spores are seen to be sphsero-tetrahedral, the surfaces marked with 
reticulated ridges, and the edges beset with short projections. 
Lycopodium contains a fixed oil and a minute quantity of a volatile 
base, methylamine. Used principally externally. 

Physiological Action and Therapeutics. — Lycopodium is an 
admirable protective, and possesses great power of absorbing oils. 
Its lightness, dryness, and absorptive power render it an excellent 
dusting powder for excoriated surfaces, eczema, herpes, ijitertrigo 
erysipelas, superficial ulcers, etc. 

Its peculiar property of not being wetted with water makes it 
a valuable protective to prevent irritation or chafing caused by the 
urine or alvine dejections of infants. 

The drug is used as a basis for insufflations and in pharmacy 
to prevent the adhesion of pills. 



784 A TEXT-BOOK OF MA TERIA MEDICA. 

PRESCRIPTIONS. 



A PRESCRIPTION (L. prce, for ; scribo, I write) is an order on the 
pharmacist to compound for the patient certain medicines intended 
to meet the requirements of the individual case. Considering it as 
an order, therefore, it should begin with the Name of the person for 
whom it is designed and the Date on which it is written. In some 
cases it may be advisable to omit the name, but the date should 
never be omitted. 

The date is often indicated by the calendar number, instead of 
the name of the month, thus : 3. | March, 3d month | 10. | day of 
the month | '96. | year | . Unfortunately, there is no uniform 
usage in this respect, some persons writing the number and others 
the day of the month first, so that a druggist unfamiliar with the 
custom of the physician could not know whether 3. 10. '96. meant 
March loth or October 3d of the year. The Latin numerals are 
also employed to designate the month : III. 10. '96. To avoid all 
chance of error, it is best to abbreviate the month or write it in 
full: March 10, 1896. The importance of the date is manifest 
from its value to the physician or pharmacist as a reference, and 
the possibility of its evidence being required in medico-legal 
contingencies. 

After the name and date comes the prescription proper, the 
name of the article required or the ingredients in case of a mixture. 
In the latter instance the various ingredients are written in a cer- 
tain order or sequence with reference to their medicinal action or 
importance, which usually is also in accord with their pharma- 
ceutical requirements for satisfactory dispensing. 

For the purpose of examination a regular prescription may be 
divided into six parts : 

1. The name of the patient and the date of the order; 

2. The superscription, or heading, indicated by the symbol ^^ 
standing for the Latin word Recipe, " take ; " 

3. The inscription, expressing the names and quantities of the 
ingredients ; 

4. The subscription, being instructions to the pharmacist or 
compounder; 

5 . The signature, containing directions to the patient or attendant ; 

6. The Name of the Physician. 




PRESCRIPTIONS. 7^5 

Example : 

^} Olei morrhuae, 
Vini albi, 

Glyceriti vitelli, q. s. ad 
Fiat emulsio.^ 
Sig. Tablespoonful after meals.* 

Here the small numeral or exponent, \ is the superscription ; ^, 
the inscription ; ^, the subscription ; ^, the signature. 

A typical prescription consists of a formula of four divisions : 

The Basis, or principal active agent ; 

The Adjuvant, or auxiliary, to aid the action of the Basis ; 

The Corrective, to correct or modify its action ; 

The Vehicle, to give proper form or taste to the whole. 

Each ingredient should have a separate Hne, although it is not 
necessary that all prescriptions should include the above complete 
formula. 

Combination of Drugs. 

In writing a prescription we assume that it is intended, as should 
always be the case, to fulfil a single therapeutic purpose only ; and 
we are to decide first, whether the medicine shall be administered 
in a solid or in a liquid form ; and second, whether a single medi- 
cine shall be prescribed or a combination of remedies. 

The drug upon which we base our expectations of success, the 
Basis of the inscription, should always be written first, and this 
drug may be the only one required. Frequently, however, some 
other drug is necessary to assist the action of the Basis, which 
substance would be the Adjuvant (Lat. adjuvare, to assist). No 
general rule can be laid down in this matter. The course to pursue 
will depend entirely upon the therapeutic indication, the physio- 
logical action of the drug, and the idiosyncrasies of the patient 
The tendency to-day, among many able therapeutists and clinicians, 
is to prescribe single drugs or simple combinations, while the pre- 
scriptions of former times are good examples of polypharmacy. 
There is, at all events, danger in going to the extreme of sacrificing 
therapeutic efficiency to simplicity of form and elegant pharmacy ; 
and it must be confessed that such compounds as Warburg's tinc- 

^ In ancient times it was customaiy to preface a prescription with a pious invocation 
to Jupiter or some guardian deity. These prayers were finally abbreviated, until they 
came to be expressed by the simple astronomical sign Qj., symbol of the planet Jupiter. 
The upright stroke across the letter R heading modern prescriptions is a curious relic of 
the above heathen usage condensed in the planetary sign. 
50 



7^6 A TEXT-BOOK OF MATERIA MEDIC A. 

ture and the bolus prescribed by Dr. Graves in the treatment of 
dropsical patients prove the efficacy of polypharmacy in many 
cases. 

Curare Base To cure 

Cito Adjuvant Quickly 

Tuto Corrective Safely 

Etjucunde Vehicle ^ 

^ > And pleasantly. 

Diluent J 

The hackneyed rule of Asclepiades that medicines should 
always be so combined as to cure quickly, safely, and pleasantly 
(curare, cito, tuto, et jucunde) has resulted in the adoption of the 
above form of inscription. 

The theoretical prescriber writes by rule, religiously avoids 
incompatibles, and would be shocked by, and have little respect 
for, a physician who should deliberately include in the same pre- 
scription the names of substances directly antagonistic to each 
other physiologically. The subject will be further discussed here- 
after. 

As a general rule, we prescribe only one drug to provoke 
emesis, and a combination of several if we wish a diuretic. A 
purgative is usually multiple, but if the selection be castor oil or 
croton oil, it will be single. 

After we have selected the Basis, or chief ingredient, of our 
prescription, the next point to determine is whether we can add 
anything which will in any manner be of real assistance to that 
Basis. This ingredient, or Adjuvant, as it is called — has usually a 
physiological action similar to that produced by combining two 
cathartics or two diuretics acting upon different portions of the 
intestines or kidneys. Sometimes, however, an Adjuvant may 
differ in its effects — as sulphuric acid serves as an Adjuvant to 
quinine, by favoring its absorption and thereby hastening and 
increasing its action, as mercury assists the action of squills upon 
the kidneys, or iron acts as an Adjuvant to a cardiac stimulant. 

The Adjuvant, as a rule, should not be directly opposed in its 
action to that of the Basis, as chloral is to strychnine, a diuretic to 
a diaphoretic, or a typical cardiac stimulant to a cardiac depressant. 

Having chosen the Adjuvant, the next point to consider is 
whether the action of the drugs selected may not be rendered 
more kindly through the addition of some other substance as a 



PRESCRIPTIONS. 787 

corrective. A substance may be added which will correct some 
disagreeable effect of the active agents by producing a medicinal 
impression upon the patient. Extract of belladonna or hyoscya- 
mus relieves the griping occasioned by some of the more violent 
cathartics, like podophyllin, and other well-known instances of this 
kind are those of the aromatic spirit of ammonia, which mitigates 
the unpleasant symptoms of iodism, and hydrobromic acid, w^hich 
lessens the untoward action of quinine. 

Again, a corrective may act by producing some chemical effect 
upon the Basis — as salicylic acid is rendered more soluble and less 
irritating by combining it with sodium carbonate or bicarbonate, 
forming the sodium salicylate. 

Great care and thought should be given not only to the Basis, 
Adjuvant, and Corrective, but also to the Vehicle, which claims 
equal attention. A prescription is often rendered more kindly, and 
no less efficient, through the medium of some substance producing 
a more agreeable taste. It is a mistaken idea that medicines, in 
order to be effective, should be repulsive to the patient. The 
homeopath's success is largely due to the very agreeable taste of 
his remedies. The mere caprice of the patient, however, should 
not be considered in the choice of a remedy when, in the best 
judgment of the physician, it is indicated. Still, it is well to study 
carefully the art of prescribing agreeable doses, so far as may be 
compatible with fidelity to science. It is to be noted that pleasant- 
ness of taste is far more important in the case of fluids than in that 
of solids. 

Aromatic elixirs, syrups, aromatic waters, etc. are in frequent 
use as Vehicles, yet it must be remembered that oftentimes a sen- 
sitive patient repudiates sweets and syrupy mixtures. In many 
cases simple syrup or pure water serves, after all, as the best vehi- 
cle, although the physician's choice must be governed mainly by 
experience. 

It will be observed that in the body of the present work, in the 
majority of cases, the method of administration is fully explained. 
It may here be noted that liquids are much more readily absorbed 
than sohds, yet adults usually prefer to take medicines in the soHd 
form, such as pills, capsules, powders, and tablets. In illness the 
patient's condition is often such that the gastric and intestinal secre- 
tions are greatly reduced, and there may not be sufficient fluid to 
dissolve the solid, so as to render it in a condition to be absorbed. 
It frequently happens, for instance, that pills are voided with the 



788 A TEXT-BOOK OF MA TERIA MEDICA. 

stools unchanged, and, on the other hand, soHd substances, such as 
pills or capsules, may remain in the intestinal canal until the secre- 
tions are restored, when the accumulated medicine will all be acted 
on at once, and, passing into solution, be absorbed in excessive 
doses. Such is the frequent cause of the cumulative effect which 
sometimes occurs, not without serious consequences. 

Even alkaloidal salts, which are readily soluble, are, perhaps, in 
many instances, best given in solution. 

Infants require Hquid medicines, water or syrup being the best 
vehicle. Bitter medicines, like quinine, may be given in aromatic 
elixir of liquorice or syrup of yerba santa. As a general rule the 
metals and their compounds should be administered in the form of 
pills or in a small quantity of fluid. The purgative salts, potas- 
sium iodide, and the diuretics, are best given in large quantities of 
fluid. 

Prof H. C. Wood, M. D., has written so clearly upon the art of 
combining, or, more correctly speaking, associating, medicines that 
we cannot do better than quote his observations verbatim: 

" The art of combining medicines is not a difficult one, but in 
practice certain principles should not be lost sight of Chief of 
these are, to prescribe as few remedies as possible, and to use no 
powerful drug without a very distinct idea of what it is intended to 
do. Whenever it is desired to give a powerful remedy in increasing 
doses until its physiological effect is produced, it should always be 
given by itself Thus, it may be necessary to give arsenic so as to 
impress the system, at the same time that iron is indicated ; but the 
two remedies should be given separately, so that the dose of either 
can be increased or diminished independently of the other." 

The principles of combination formulated below were long ago 
enunciated by Dr. Paris, but are to-day as imperative as ever. 
Medicines are combined — 

" First. To augment, correct, or modify the action of a medicine. 
Thus, purgatives act much more kindly when a number of them 
are united together. The chief reason of this probably is that, as 
different remedies affect different portions of the gut, the whole in- 
testine is best reached by a union of the diverse substances. It 
may take an intense irritation of the mucous membrane to purge 
as actively as does a mild irritation of both the mucous membrane 
and the muscular coat. 

*' There are powerful medicines which act similarly upon some 
parts of the organism, but dissimilarly upon other parts. By com- 



PRESCRIPTIONS. 789 

bining such remedies powerful effects can be obtained at the points 
where the two hnes of action cross each other, without influencing 
to a great extent other portions of the system. Thus, chloral pro- 
duces sleep by its action upon the brain, and also has a distinct 
influence upon the heart, but none upon the intestinal tract. Mor- 
phine acts upon the brain, and does not influence the heart, but has 
a powerful effect upon the intestinal tract. By combining chloral 
and morphine we get an overwhelming conjoined influence upon 
the brain in producing sleep, with the least possible disturbance of 
the heart and of the intestinal tract. 

" Second. To obtain the joint action of two or more diverse 
remedies. Thus, in a cough-mixture morphine may be included to 
quiet the cough, whilst ipecacuanha and squill (in accordance with 
the first principle) are added to affect the mucous membrane. The 
application of this principle requires caution, or the practitioner 
will be led into that chief abomination — polypharmacy. It is worse 
than futile to attempt to prescribe for every symptom. It is the 
underlying cause of the disorder, or the under-stratum of bodily 
condition, which must be sought out and prescribed for simply. 

" TJiird. To obtain a special combination which is really a new 
remedy, or which experience has shown acts almost as a new 
remedy. Thus, when to potassium iodide in solution corrosive 
sublimate is added a new chemical compound (potassio-mercuric 
iodide) is formed, which experience has shown to be of great value 
in syphilitic diseases. Griffith's antihectic mixture (mistura ferri 
comp.) is another instance of the use of chemical changes, the 
protocarbonate of iron (ferrous carbonate) being formed out of 
the sulphate of the metal and the potassium carbonate. In the 
famous Dover's powder no chemical change occurs, but the ordi- 
nary action of opium upon the skin is so enhanced by the ipecac 
that the combination may be looked upon almost as a new remedy. 

''Fourth. To afford a suitable form. Thus, acacia is added to 
make an emulsion, or confection of rose to make a pill. In the 
choice of excipients care should be exercised to select a substance 
free from medicinal properties, having no chemical incompatibility 
with the medicinal agent and of suitable physical character. Bread- 
crumb often makes a good excipient for pills, but with silver 
nitrate it is chemically incompatible, on account of the sodium 
chloride it contains. 

" When writing a prescription the utmost care should be taken 
to use such excipients that the combination should not only be 



790 A TEXT-BOOK OF MATERIA MEDICA. 

attractive to the eye, but also as little repulsive to the palate as 
may be. Whenever possible the pill form should be employed 
with bitter or disagreeable medicines. The pill may be readily 
coated with silver-foil ; tonic pills may be coated with iron by 
shaking or roUing them in ferri pulvis while soft and sticky. 
Sugar-coated pills and * compressed pills' are apt to get so hard 
and insoluble that their use requires caution. In regard to mixtures, 
flavoring oils should be freely used, and the power of glycerin to 
conceal the disagreeable taste of many substances should be 
remembered." ^ 

As vehicles for liquid mixtures for internal use the following 
classes of official preparations are best adapted — The aromatic 
waters : rose, anise, fennel, and the mints when flavor alone is 
desired, the most delightful flavor of all being orange flower 
water. The aromatic syrups : orange, orange flower, and tolu 
when it is desired to disguise the taste and to suspend resinous or 
otherwise sparingly soluble substances in the mixture. The elixirs 
when in addition to agreeable flavor it is desirable to employ a 
vehicle as a solvent for certain salts not readily soluble in water or 
syrups. The elixirs containing about 25 per cent, of alcohol, they 
are useful vehicles for tinctures and fluid extracts of resinous 
drugs such as cubeb, buchu, uva ursi, valerian, viburnum, etc. 

When flavor alone is desired the elixir aromaticum, U. S. Ph., 
a delightful combination of orange and other aromatics, should 
be used. To disguise the taste of bitter drugs, as in the last men- 
tioned, elixirs of licorice, or of eriodictyon (yerba santa) are mostly 
employed. 

Incompatibility. 

Due regard is to be paid to the mutual chemical, pharmaceutical, 
and therapeutical relations of the drugs combined in a prescription. 

When different substances, whether liquid or solid, are com- 
bined or associated and undergo a more or less complete change, 
they are said to be incompatible, the incompatibility consisting of 
three kinds : chemical, pharmaceutical, and therapeutical, although 
the last division is not scientifically correct, since one substance 
cannot be therapeutically incompatible with another, although it 
may be a physiological antagonist. 

The incompatibles and antagonists of the different substances 
are fully mentioned under the respective drugs. The principles 
governing incompatibility, however, may well be considered here. 

^ Therapeutics, 7th edition, pp. 108 et seq. 



PRESCRIPTIONS. 791 

Chemical incompatibility is of the most importance. 
The commonest forms of chemical incompatibility occur under 
the following conditions : 

1. When a new and insoluble salt is formed, resulting from a 
mixture of solutions of soluble salts. Example (i) : mixing solutions 
of lead acetate and zinc sulphate, both soluble salts, but producing 
by chemical decomposition a new and insoluble salt, the sulphate 
of lead, which is precipitated. 

2. By the addition of a strong acid to solutions of salts of 
weak or volatile acids, such as carbonates and bicarbonates, with 
resulting decomposition. Example (2) : ammonium carbonate, the 
salt of a weak acid radical, added to syrup of squills, containing 
acetic acid, causes decomposition to take place, with effervescence 
and the liberation of carbonic acid gas. 

3. Salts of a feeble or volatile base are decomposed by the 
addition of a strong alkali. Example (3) : the evolution of ammonia 
when a strong alkali is added to ammonia alum, and when chloral 
hydrate is decomposed by alkalies, such as aromatic spirit of 
ammonia, lime solution, etc. 

4. Alkaloids, or their salts, are thrown out of solution or pre- 
cipitated from their solutions by the addition of alkalies or alkaline 
salts. Example (4) : sulphate of strychnine in solution is precipitated 
as the insoluble bromide of strychnine by the addition of a larger 
proportion of potassium bromide. Quinine sulphate is precipitated 
as insoluble quinine acetate when mixed with a solution of potas- 
sium acetate. 

5. Tannic and gallic acids and preparations containing them, 
as well as many other vegetable acids, produce discoloration or 
precipitation of iron and many of its compounds. Example (5) : ink 
is the best illustration of this incompatibility. Writing fluids are 
usually combinations of tannic or gallic acid with some preparation 
of iron. Add the tincture of ferric chloride to tincture of cinchona, 
and notice the discoloration. 

There are certain preparations of iron, like the compounds with 
ammonium or sodium citrate (see tinct ferri citro-chloride, N. F., 
tasteless tincture of iron) which produce little discoloration with 
vegetable astringents, and none at all with vegetable preparations 
containing no tannic or gallic acid. 

Pharmaceutical incompatibility is the production of fewer or 
more insoluble substances in mixtures or preparations of vegetable 
drugs, associated or not with any chemical compounds. Pharma- 



792 



A TEXT-BOOK OF MATERIA MEDICA. 



ceutical incompatibility may occur in liquids or solids, although 
much more frequent in liquid mixtures, causing a separation of 
either inert or active ingredients. Examples : vegetable tinctures 
of resinous drugs with water, such as tincture of guaiac and water ; 
copaiba and oils with aqueous preparations ; spirit of nitrous ether 
with mucilage of acacia, etc. The separation or precipitation may 
frequently be prevented by the intervention of some viscid sub- 
stance, such as syrup, glucose, glycerin, mucilage of acacia, etc. 

Incompatibility may be both chemical and pharmaceutical. In 
the following list the substances which cannot be classed as incom- 
patible under any of the above divisions are given for reference : 



wSUBSTANCE. 

Acacia . . . . 
Acids in general 

Acid. 

Arsenous. 
Salicylic 

Tannic . 



Bismuth. 

Subnitrate 
Chloral. 

Hydrate . 

Iodine . . . . 



Lead. 
Acetate 



Mercury. 
Bichloride 
Mild chloride 
(Calomel) 

Potassium. 

Chlorate . . 



Iodide 



Permanganate 

Sodiu?n. 

Bicarbonate . 
Bromide . . 

Silver. 

Nitrate . . . 



Incompatible with 

Alcohol, alcoholic and ethereal tinctures ; * borax ; ferric 
chloride; lead salts. 
\ Alkalies, alkaline solutions; metallic oxides. 

■\ Ferric hydrate; magnesia; lime water. 

\ Iron compounds ; potassium iodide ; * lime water. 

(• Alkalies, carbonates and bicarbonates ; lime water; chlorine 

\ water ; albumin ; gelatin. 

■< Calomel;* sulphur; tannin. 

r Alkalies, carbonates ; * ammonium and mercury compounds ; 
\ potassium bromide and alcohol. 

^ Ammonia ; * alkalies, carbonates ; chloral ; metallic salts ; 
I starch.* 

{Acacia ; acid hydrochlor. ; acid sulphuric and sulphates ; 
ammon. chloride ; carbonates ; lime water, iodine ; potas- 
sium iodide ; tannin. 



\ 



Potassium iodide ; * salts, carbonates ; tannin ; borax. 



f Acids, acid salts; alkalies, carbonates; ammon. chloride; 
\ iodine ; potassium iodide ; ferric chloride, iodide ; sulphur. 

/ Acids, mineral ; calomel ; organic substances ; sulphur. 

( Acids, acid salts ; alkaloids ; iron ; lead and mercury salts ; 
t potassium chlorate ; silver nitrate ; chlorine water. 

^ Ammonia, salts; alcohol; glycerin; ethereal oils; organic 
{ substances. 

Acids, acid salts; acid, tannic; alkaloids; metalhc salts. 



\ Acids, mineral ; chlorine water ; mercury compounds. 

{Acids, acetic, hydrochloric, hydrocyanic, sulphuric, tartaric, and 
their salts; alkalies, carbonates; iodine; potass, iodide, 
bromide; sulphur. 

Those marked with an * are sometimes directed to be compounded for the purpose 
of effecting some special change or producing new compounds. 



PRESCRIPTIONS. 793 

Among the above, potassium permanganate forms an explosive 
mixture with glycerin ; so does chromic acid. Chlorates of potas- 
sium, etc. explode when triturated with sulphur. The strong acids, 
nitric and sulphuric acids, and especially mixtures of these, react 
so strongly with volatile oils (hydrocarbons) as to cause explosion. 
Iodine affects these oils in the same way — fulminates. 

It not infrequently happens that the physician intentionally 
writes a chemically incompatible prescription. '* Black wash " and 
*' yellow wash " are examples. Other instances are such pharma- 
copceial preparations as Hquor ammonii acetatis, mistura ferri com- 
posita, and liquor magnesii citratis. 

Physiological antagonists are often given together, as atropine 
-and morphine, or aconite and digitalis in certain cases of cardiac 
arrhythmia. 

No general rule can be laid down for the avoidance of so-called 
therapeutical incompatibility. Some of our most valuable drugs 
contain active principles which are physiologically opposed to each 
other in their action ; instance : jaborandi, which contains two abso- 
lutely antagonistic alkaloids, pilocarpine and jaborine, the latter in 
small quantity, yet sufficient to control the action of the former. 
Digitalis contains several distinct principles, one of which, digi- 
tonin, is the direct antagonist of the others. 

Opium is a conspicuous example of a complex remedy, con- 
taining, besides gum, sugar, etc., eighteen different alkaloids, two 
neutral principles, and two peculiar acids ; so that a prescriber of 
this drug, while he may, perhaps, flatter himself that he is con- 
forming strictly to the present notions of pharmaceutical simplicity, 
is in effect a polypharmacist of most pronounced type. Moreover, 
not only are the constituents of opium very numerous, but, like 
others mentioned, the drug affords in its thebaine and morphine 
a further illustration of direct physiological antagonism. 

The author cannot too strongly recommend that physicians 
ignorant of the physiological action of drugs in large and small 
doses, if they prescribe at all, should avoid including many reme- 
dies in one prescription. Such practitioners had best adhere to a 
single remedy or adopt homeopathy. But, given a competent and 
thorough knowledge of the action of drugs and the exact condi- 
tion of the patient, the physician is justified in giving one or twenty 
drugs in the same prescription, since he is perfectly familiar with 
the several agents of relief, and can foretell with nicety the effect 
to be produced by their combination ; and in all cases a physician 



794 ^ TEXT-BOOK OF MATERIA MEDICA. 

should be as certain of the action, strength, and reliability of the 
drugs he administers as the surgeon of the aseptic condition of his 
hands and instruments. 

Estimation of Amounts in a Prescription. 

Having decided upon the various ingredients which are to enter 
into the prescription, the next consideration is the amount of each 
desirable. 

In the first place, do not prescribe more than the prognosis 
seems to call for. If in your judgment the patient will not require 
medicine more than five or six days, and not oftener than three 
times a day, a two-ounce mixture should be prescribed if a liquid,, 
or the required number of pills, powder, capsules, etc. if a solid^ 
is desired. 

In prescribing liquid medicines note must be taken of the 
several sizes of medicine-vials, their capacities being in this coun- 
try I, 2, and 4 fluidrachms, and i, 2, 3, 4, 6, 8, 12, and 16 fluid- 
ounces. In the larger cities vials may also be had of metric 
capacities — 30, 60, 90, 120, 240, and 500 Cc. While it is not 
essential, it is in much better taste to have a prescribed mixture 
aggregate just a bottleful of one of the above sizes. Where two 
different mixtures for the same person are prescribed, or differ- 
ent mixtures for different persons in the same house or family,, 
it is well to order them put up in vials of different sizes to avoid 
confusing the medicine. This is especially desirable when both 
internal and external remedies are prescribed for the same person. 

The amounts of the ingredients requisite for any given prescrip- 
tion are determined in various ways. The amount of the active 
ingredients will of course be the product of two factors, the quan- 
tity of dose and the number of doses required ; and the quantities 
must be such as can be expressed in the system of weights and 
measures adopted, and indicated by round numbers such as best 
conform to the relation between the denominations of the particular 
system followed in the prescription. 

There is no difficulty in computing the amounts in a solid mix- 
ture, powders, pills, or suppositories, especially if ten or its multiple 
is prescribed, nor in external preparations, where the strength is 
expressed by percentage, and are therefore most conveniently and 
accurately prescribed according to the metric system ; but many 
additional considerations occur in estimating amounts in fluid 
mixtures. 



PRESCRIPTIONS. 795 

Frequently solids like salts, etc. are prescribed in solution, but 
their bulk may be safely disregarded in the estimation of amounts 
of the liquid measure ; for a solid in the quantity usually prescribed 
increases the whole volume of the solution but very little. Ordi- 
narily a fluidrachm (4.0 Cc), or a teaspoonful, should not contain 
over 5 grains (0.32 Gm.), nor a tablespoonful, or 4 fiuidrachms (15.0 
Cc), over 20 grains (1.29 Gm.), of a solid in solution, unless the 
substance be very bland, when twice these quantities are permissible. 

The following is a very simple rule for estimating amounts in 
Apothecaries' Measure : 

In an eight-ounce mixture, the dose being a drachm, take as 
many dj^achms of the medicine as there are w^anted minims or 
grains to the dose. It will be observed that in this case the basis 
is an eight-ouncQ mixture, yet it typifies the rule, which, when 
thoroughly understood, may easily be applied to a four-ounce or a 
two-ounce mixture, one-half or one-fourth as many drachms ; 
while if the dose is to be a dessertspoonful, or two drachms, it is 
only necessary to take one-half diS many drachms to an eight-ounce 
mixture, reducing for smaller mixtures in accordance with the rule. 
If the dose be a tablespoonful, or four drachms, one-fo2Lrth as many 
drachms must be taken to an eight-ounce mixture as there are 
minims or grains to the dose. This rule, while not fractionally 
exact, is sufficiently accurate for all practical purposes. 

Examples : We desire to give an eight-ounce mixture, with a 
drachm for a dose, each dose to contain 12 grains of potassium 
bromide and 10 grains of chloral, the vehicle to be syrup of orange 
and water. We have here, then, 64 doses of a drachm each : to be 
exact, therefore, we should have "j^Z grains of potassium bromide, 
or 12 drachms and 48 grains; but, following the rule, w^e put in 
the mixture 12 drachms, since we desire 12 grains to the dose. 
Of chloral we would require exactly 640 grains, or 10 drachms 
and 40 grains, but we use the round number, 10 drachms, in the 
mixture. We see that in each case there is but the fraction of a 
grain short in the dose. 

The prescription would consequently be written as follows : 



Potassii bromidi, 


5xij ; 


Chloralis, 


3x; 


Syrupi aurantii, 


^iv; 


Aquae, 


q. s. ad iviij. 



M. et ft. sol. Sig. Teaspoonful for a dose. 



796 A TEXT-BOOK OF MA TERIA MEDICA. 

This is more of each ingredient than should be prescribed in a 
fluidrachm. It were better, then, that the dose should be a dessert- 
spoonful, or two drachms ; and in order that the two teaspoonfuls 
should contain only 12 grains of potassium bromide and 10 grains 
of chloral, the whole amount of the medicament must be divided 
by 2 — i. e. the prescription should read : 

^. Potassii bromidi, 3vj ; 

Chloralis, 3v ; 

Syrupi aurantii, ^iv ; 

Aquae, q. s. ad ^viij. 

M. et ft, sol. Sig. A dessertspoonful for a dose. 

In case the prescription be for a four-ounce mixture, with a 
dessertspoonful for a dose, the amounts of the solid substances 
would, of course, be one-half, and if for a two-ounce mixture, one- 
fourth of the above. 

When writing a prescription put down first all the ingredients 
which are to enter into the combination, and after the last one, 
which is usually the vehicle, write the whole amount ; i. e. if it is 
to be a four-ounce mixture, write after the name of the vehicle 
'' q. s. ad f^iv." Then begin with the Basis, the first ingredient, 
and write the amount required in the whole mixture. In other 
words, decide upon the doses to be given after the medicines have 
been selected. 

It is important to adopt as a golden rule to carefully and delib- 
erately read over the entire prescription before it is handed to the 
patient, and more especially to scrutinize each item and the quanti- 
ties to guard against transposition of the latter, which otherwise 
may result in a fatal error. 

The next thing to be determined is the manner in which the 
medicine should be measured out to the patient for internal use. 
A graduated medicine-glass is always preferable to a domestic 
measure, and should be ordered in all cases.. Teaspoons, as 
well as dessertspoons and tablespoons, vaiy considerably, besides, 
owing to adhesion, may, according to the manner in which they 
are filled, show a variation of nearly 50 per cent, in their capacity. 
A teaspoonful, considered to be equivalent to one fluidrachm, may 
contain from one-half to two fluidrachms ; a dessertspoonful, which 
should be equivalent to two fluidrachms, and a tablespoonful, equal 
to one-half fluidounce, vary almost as much in capacity. 

It is necessary to be exact in the administration of medicines, it 



PRESCRIPTIONS. 



797 



^pppoppppopooooppop 
b^Oa u) N) lo "•-' « b b b b b b b b b b b 

(-n ^/i U> ONU» Mi-ii-iOOOOOO 

Ui M CnU) On tsJ i-i 1-1 O O 

UH.nOJ 00 ON 


f 


O 

3 

c" 

o 

:r 

CL 


! 

s 
o 

1 

1 

1 

1 

1 
9~' 


1 
1 

.^ 

j 

1 
1 

1 

s 

;^ 

r 

5. 


o^ . . . = =. « - - - . .| 

■ <-a ;-n Oj _W jg |H j-i pCK) _« _, |_ OS to ►_ « p O 
r ' ■ ■ On ■ dj ■ <Ji to OsUl ■ 0^ 6i dj ■ 'oo On 


> 

cr 
cr 

< 




Equiva- 
lent. 
Grs. 


K)«i-,0000000000000000 

• C- o^^-^^'t^-o o o o b b b b bo 

<-ntO(jn Uit-ri(s>to«i-i 
On ^4 U) 


O 


o 

c 

3 
^' 

2, 

trq 

? 

c 

5' 
a- 
3 
S 

c 

o 

s 

3 
? 

V 

i? 

CL 

o 

3 

o 

o 

o" 

-t 
n> 

3" 
O. 
O 


(^^^^ppppppppppppppp 

' On " "^ osoo u»ts5i-<bbbbbbbbb 

Cfi ^j (^OjC^mOOOOO 

-J -40J Oj to U. 
On ^J On 


Oi 


ON-^ UJtOiiwOOOOOOOOOOOOO 
• • • • <>^ioi^bs^-to"bbb bo bob 

on on ^J ONOn ^ 


^ 


p onoi u) to to _« "I p p p p p p p o o o o 
■ On ■ ■ On * oj " ON'dj ■« « « b b b b b b 

On to CnOj On to w « O O 

On on Oj CX On 

On On 


^ 


oj 00 pN-f^ Oj to HH hH p p o p o o o o o o o 
Ononu> bo-fi. io w "« b b b b b b 

On OJ OOOJ m nh w O 
On to 00 


^ 


y^P'^j-f^ojojwwwppopoppooo 

■ Cn On 4i«. ' ^ On * oi to to *-« 'w b b b b b 
On On oj to — M i-< 
^J On to 




00 to VO On 4^^ OJ to HH |-i p p O O p p p O p p 

* ' ■ 4^ On onuj 00 to onoj to b « b b b b b 

Ol«tO-|^tO'->wi-i 
00 OiOn OCOn tO 


^ 


O u3 O ONOi 4i. to to HH O p p p p p p p p p 

oi ' u) oMJo to "to "« b b b b b 

OntOOi OjOntOtONHHH 
on ^ U) 


M 

o 
o 


.^ o^ to "^r pN-f'- oj to _>-i p p p p p p p p p p 
On ' to ' bo ' di "on bo-fi' oj to w b b b b b 

On On OnC«J to to « 
-^ On 


to 

o 


Oj to « 

p p v^ "o -^i onoj (^^^ppppppppp 

* On ' «<l ' * ' On -f^ oj to b b b b b 
j; -^r 4^ oj to to 

On On 


^ 


OnOo 00OvO*^4^Oj to M O p P P P P P P 

* 4i. * bo " to "<r ON-f^ « "oNon do to b b b b b 

on ONOi \0 4^ -P' C^ to 
On On 


M 

00 

o 


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p on p to p pOOn 4^^ tO |-i O O p P O p p O p 

Or dj ONdm -fi. to 1-1 b b b O 

On On On 4^ Oj to 

Oi On 


8 


00 t-i 4^ 4^. to vo pooi U> -1 p p p p O p p p p 

to On " On * * to On bo ONOn dj -<I O O O O 

On to to On4^ 4^ ^-^ 

On to 


to 

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VO On4^ to to 1-1 1-1 1-1 O 

On to poNO 4^ vp to p onoj 'r^'T'r'PPPPPb 

' -P>. * " * to on * On Ih ON to ' On to M b b On 
Ov 4=' to VO 004^ 


o 


O ONOn OJ to to 1-1 >-i 

ponp ponpOJ p pNOJ _m -i m p Q p p O p 

on to ONdj ' On to « ">-i bo ON 
Oi On OJ On On 


o 
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O U) O ONOn 4i. to to OI 

p p p p P P p^ p U) OnOj to to >-i p p p p p 

4^ to ON ' dj On to to « « 
On ^OJ 


i 



798 A TEXT-BOOK OF MATERIA MEDIC A. 

being well known that the action of drugs varies greatly with the 
size of the dose, small doses in their action being often directly 
opposite to large doses. 

Ordinarily, it is unwise to prescribe medicines to be dropped 
out, since a drop varies greatly in dimension according to the vis- 
cosity and specific gravity of the fluid, the shape, size, and charac- 
ter of the neck and lip of the bottle, as well as its degree of fulness, 
and the steadiness of the hand in dropping. 

In computing doses of powerful medicines, therefore, always 
estimate for minims instead of drops. 

Direct the use of a " dropper " or minim pipette for the admin- 
istration of liquids by drop doses, such as Fowler's solution, 
collyria, etc. There are exactly sixty minims of any fluid to one 
fluidrachm, while sixty drops may be fewer or more than one 
drachm, as the following Hst shows : 

Drops in f 5j Weight of f5j. 

(60 M.). Gr. Gm, 

Acidum Carbolicum ill 59 3.82 

Acidum Sulphuricum Aromaticura .... 146 53 3.43 

^ther Fortior 176 39 2.52 

Chloroformum Purificatum 250 80 5.18 

Creosotum 122 56^ 3.66 

Ext. Belladonnse Fluidum 156 57 3.69 

Ext. Colchici Radicis Fluidum 160 55 3.56 

Ext. Digitalis Fluidum 134 62 4.01 

Liq. lodi Compositus 63 59 3.82 

Liq. Potassii Arsenitis 57 55 3.56 

Oleum Caryophylli 130 57 3.69 

Oleum Tiglii 104 50 3.24 

Spiritus Ammonise Aromaticus ..... 142 48 3.1 1 

Syrupus Ferri lodidi , . 65 77 4.98 

Syrupus Scillae Compositus 102 70 4-53 

Tinctura Aconiti 146 46 2.98 

Tinctura Belladonnge 137 53 3-43 

Tinctura Cantharidis 13I 51 3.33 

Tinctura Ferri Chloridi _. . 150 53 3.43 

Tinctura Nucis Vomicae 140 44 2.85 

Tinctura Opii 130 53 3.43 

Tinctura Veratri Viridis 145 46 2.98 

Vinum Colchici Seminis 11 1 54 3.49 

Language and Grammatical Construction of Prescriptions. 

A prescription is written partly in Latin, partly in English. The 
name of the patient and the date should be in EngHsh ; the super- 
scription in Latin abbreviations ; the inscription in Latin ; the sub- 



PRESCRIPTIONS. 799 

scription in Latin or Latin abbreviations ; and the signature, or 
directions to the patient, in English. 

A prescription properly and unmistakably written is a cardinal 
requisite to the successful administration of medicine, no less than 
to its correct preparation by the druggist. Every practitioner and 
pharmacist should possess some knowledge of Latin grammar, yet 
by the observance of a few simple rules one wholly ignorant of 
the language may acquire a proper use of the forms generally 
adopted ; and a little study, aided by constant practice, will soon 
fix in the memory the peculiarities of gender, case, and number, 
together with the agreement of adjectives, to be met with in all 
prescriptions. 

It is to be observed that the Latin tongue has been chosen 
as the medium of medical and pharmaceutical instructions because 
of its conciseness, stability, and universal acceptance by the scien- 
tific world. Moreover, the Latin name is specific, while the English 
name may refer to several drugs of entirely different properties : 
for instance, " Snake root," applied by residents of this or that 
locality to Cimicifiiga racemosa, Aristolochia serpentaria, Asarum 
Canadense, Eupatormin aromaticum, Polygala Senega, etc. 

To begin with, then, the prescription-writer must endeavor to 
lay aside English and familiarize himself with various Latin verbs 
(most of them in the imperative, or commanding, mood) ; a long list 
of drugs and medicines, to be correctly written and pronounced ; 
a limited number of adjectives, agreeing in gender, case, and number 
with the nouns they qualify ; a few prepositions governing certain 
fixed cases ; and a small number of terms and phrases of general 
importance. Let us consider them seriatim. 

Verbs. 

The first item of a prescription is a verb : recipe, " take," the 
sign being ^. One need not know the conjugation of the Latin 
recipere to understand the import of this order. Such imperatives 
simply signify the instructions of the physician. 

A very few verbs are used in the subjunctive mood, having the 
force of the imperative, such as flat, pi. fiant, '' let it, or them, 
be made (into, in pihdas) ; or '^ let be made," as in the ex- 
pression /2<3:/ mistura, "let a mixture be made"; snff Iciat, '' vadiy 
suffice," as in the common instruction, abbreviated *' q. s.," quantum 
sufficiat, "as much as may be required "; ne repetdtur, " do not let 
it be repeated," or " do not repeat "; bulliat, " let it boil." 



8oo A TEXT-BOOK OF MATERIA MEDICA. 

A future passive participle is also frequently used : dividendus, 
like an adjective agreeing with the noun in gender, case, and num- 
ber, and signifying *' to be divided (into)," as in the order in tro- 
chlscos dividenda (massa), " to be divided into troches," though the 
imperative divide^ " divide into," is often used. 

Nouns. 

These form by far the largest vocabulary, including all official 
and nearly all unofficial drugs and medicines, together with their 
compounds. A considerable number, ending in a, are of the first 
declension, all feminine.^ Example : 

Singular. 

Nominative. — Oliva — Olive (subject). 

Genitive. — Olivae — of Olive. 

Accusative. — Olivam — Olive (object). 

Ablative. — Ollva — with Olive. 

Plural. 

Nom. — Olivse — Olives (subject). 

Gen. — Olivarum — of Olives. 

Ace. — Olivas — Olives (object). 

Abl. — Olivis — with Olives. 

[The Latin dative and vocative cases are never used, and the plural number rarely.] 

An extensive list of medical agents ends in us (generally 
masculine) or um, on (neuter), and are of the second declension. 
(Prinos, masc, is exceptional.) Example : 

Singular. 
Nom. — Oleum — Oil (subject). 
Gen. — Olei — of Oil. 

Ace. ■ — Oleum — Oil (object). 
Abl. — Oleo — with Oil. 

Plural. 
Nom. — Olea — Oils (subject). 
Gen. — Oleorum, Oleiim — of Oils. 
Ace. — Olea — Oils (object). 
Abl. — Oleis — with Oils. 

^ The genders of nouns are given as a guide to the agreement of adjectives. 



PRESCRIPTIONS. 8oi 

It may be noted, in passing, that the genitive singular is almost 
exclusively used in prescription-writing. 

We are now prepared to analyze a simple prescription and 
understand its elements. 

Referring to the foregoing examples, suppose we wish the drug- 
gist to supply three drachms of olive oil. We prescribe as follows : 

I^. Olei Olivae ^iij. 

Recipe, Take of oil of olives three drachms. 

It must be borne in mind that the direct object of the imperative 
recipe in this example, as well as in all similar cases, is not the 
medicine olenni, but the amount of it prescribed, as indicated by 
the Roman numerals and the symbol of Apothecaries' weight, 
which, written in full, would be tres drdclinias (ace). In this class 
of prescriptions, therefore, including nearly all in use, we need con- 
sider only the genitive, the accusative or grammatical object of the 
verb being expressed in the quantity symbolically indicated. 

It will be noted, moreover, that the construction, or order, of 
the Latin words is the reverse of English usage. Yet it is evi- 
dent that a grocer's clerk, for instance, might well, and frequently 
does, employ the same mode of expression : 

(of) Granulated Sugar Bbs lo — 

a construction precisely analogous to that of the above prescrip- 
tion, which simple form may be taken as a type for all, subject to 
such modifications as the nature of the drug and the treatment 
may require. 

Nouns of the second declension ending in on, all neuter, are of 
Greek derivation, and are declined like oleitm. Example : 

Singular. 
Nom. — Toxicodendron. 
Gen. — Toxicodendri. 
Ace. — Toxicodendron. 
Abl. — Toxicodendro, etc. 

Prinos, also of Greek origin, is declined: 

Nom. — Prinos. 
Gen. — Prini. 
Ace. — Prinon. 
Abl. — Prino, etc. 
51 



802 



A TEXT-BOOK OF MA TERIA MEDICA. 



The remaining nouns of the second declension all end in its 
(with four exceptions, masculine), and are declined like the follow- 
ing example : 

Nom. — Junlperus. 

Gen. — Juniperi. 

Ace. — Juniperum. 

Abl. — Junipero, etc. 

Indeed, all prescription nouns ending in us are of the second 
declension, save seven : 

Nom. Gen. 

Rhus, Rhois, 3d fern. 

Comus. COrnus, \ ^^^^^^^ 

Quercus, Quercus, j 

Fructus, Fructus, >, 

Haustus, Haustus, 

Potus, Potus. [■4thmasc. 

Spiritus, Spiritus, J 

The four exceptions to the masculine gender mentioned are : 

Juniperus, ^ 

Prunus, 11 r 

' \ all fem. 
bambucus, I 

Ulmus, ^ 

With these — to be committed to memory — the second declen- 
sion ends, so far as it concerns the prescription-writer. 

While touching upon the fourth declension it may be well to 
complete the study of it, there being but six nouns, ending in us, 
of this declension (Rhus is of the third). They are, as already 
enumerated : 

Cornus, 

Quercus, 

Fructus, 

Haustus, 

Potus, 

Spiritus, 



and are thus declined : 



Smgtdar. 
Nom. — Spiritus. 
Gen. — Spiritus. 
Ace. — Spiritum. 
Abl. — Spiritu. 



PRESCRIPTIONS. 803 

Plural. 
Nom. — Spiritus. 
Gen. — Spiritum. 
Ace. — Spiritus. 
Abl. — Spiritibus. 
We now come to the third declension, to which belong all 
nouns not included in the foregoing first, second, and fourth, the 
fifth Latin declension, like the dative and vocative cases, not 
being used in prescriptions. All nouns, with seventeen exceptions, 
having terminations other than a (except four), tis, tun, and on, are 
of the third declension. 

Here the changes from nominative to genitive and other cases 
are quite variable, and may be best remembered by arranging the 
nouns in groups according to their nominative endings, with ex- 
amples of their several declensions. 

Group I. — Thirty-three nouns ending in as make the genitive 
in atis. All are masculine save Asclepias (Gen. Asclepladis), which 
is feminine, and all are names of salts. Example : 

Singular. 
Nom. — Nitras. 
Gen. — Nitratis. 
Ace. — Nitratem. 
Abl. — Nitrate, etc. 
Group II. — 

Nouns ending in is : 
id) Genitive unchanged ; all feminine. 

Ex. Nom. Cannabis ; Gen. Cannabis. 
(^) Genitive changing into itis, all masculine. 

Ex. Nom. Arsenis ; Gen. Arsenltis. 
ic) Genitive changing into idis, all feminine. 

Ex. Nom. Hamamelis ; Gen. Hamamdidis. 
id) Genitive changing into eris, one only, mascuhne. 
Ex. Nom. Pulvis ; Gen. Pulveris. 

Group III. — 

Nouns ending in 0, all feminine except Carbo, Pepo, and 
Sapo, which are masculine : 
(a) Genitive ending in onis. 

Ex. Nom. Lotio ; Gen. Lotionis. 
{b^ Genitive ending in inis. 

Ex. Nom. Mucilago ; Gen. Mucilaginis. 



8o4 A TEXT-BOOK OF MA TERIA MEDICA. 

Group IV. — 

Nouns ending in x, masculine or feminine : 
{a) Genitive ending in cis. 

Ex. Nom. Borax ; Gen. Boracis. 
(b) Genitive ending in cis, and the last vowel of the nomina- 
tive {e) changed to i. 
Ex. Nom. Rum^x; Gen. Rum/cis. 

Group V. — 

Nouns ending in r, masculine or neuter : 
Genitive simply adds Is. 

Ex. Nom. Liquor; Gen. Liquoris. 

Group VI. — 

Nouns ending in a, all neuter : 
Genitive ends in dtis. 

Ex. Nom. Enema ; Gen. Enematis. 

Group VII. — 

Nouns ending in s, masculine or feminine : 
Genitive ends in Is. 

Ex. Nom. Adeps ; Gen. Adipis. 

Group VIII. — 

Nouns ending in /, all neuter : 

(a) Genitive simply adds Is. 

Ex. Nom. Chloral ; Gen. Chloralis. 

(b) Genitive doubles / and adds is. 

Ex. Nom. Mel ; Gen. Mellis. 

Group IX. — 

Nouns ending in it, all neuter : 
{a) Genitive ending in onis (nominative in on). 

Ex. Nom. Limon ; Gen. Limonis. 
{b) Genitive ending in inis (nominative in e7t). 
Ex. Nom. Semen ; Gen. Seminis. 
[Erigeron has the genitive Erigerontis.] 

Group X. — 

One noun ending in c, neuter : 
Genitive simply adds is. 

Ex. Nom. Lac ; Gen. Lactis. 

In conclusion, there are a number of indeclinable nouns, such 
being all neuter, of various endings and derivations. 



PRESCRIPTIONS. 
Adjectives. 



805 



These are many, and, as has been said, their agreement in 
gender, case, and number with the nouns they quahfy is of para- 
mount importance in correct prescription-writing. They are de- 
chned Hke nouns of different declensions, having the same cases 
and numbers, and may be divided into two classes. 

Class I. includes all but fourteen of the adjectives used in pre- 
scriptions. The nominative has three distinct endings : us, mascu- 
hne, declined like the second declension of nouns; a, feminine, 
decHned like the first declension ; and um, neuter, declined like the 
second declension. Example : 



Singular. 



Nom. 
Gen. 
Ace. 
Abl. 



(2d decl.) 
Masc. 

Fluidus, 
Flaidi, 
Fluidum, 
Fluido. 



(ist decl.) 
Fern. 

Fluida, 
Fluidae, 
Fluidam, 
Fluida. 



(2d decl.) 

Nent. 

Fluidum. 
Fluidi. 
Fluidum. 
Fluido. 



Plural. 
Nom. Fluidi, Fluidae, Fluida. 

Gen. Fluidorum, Fluidarum, Fluidorum. 
Ace. Fluidos, Fluidas, Fluida. 
Abl. Fluidis, Fluidis, Fluidis. 

Class II. includes the remaining fourteen adjectives in use. 
These, with few exceptions, have two, instead of three endings : 
one in is for both masculine and feminine genders, and another 
in e for the neuter. Adjectives of this class are declined like nouns 
of the third declension. Example : 



Singular. 




Masc. and Fern. 


Neut. 


Nom. Dulcis, 


Dulce. 


Gen. Dulcis, 


Dulcis 


Ace. Dulcem, 


Dulce. 


Abl. Dulci, 


Dulci. 



(The form Dulce is sometimes wrongly used for the ablative.) 



8o6 



TEXT-BOOK 


OF MA TERIA MEDIC A, 




Plural. 




Nom. Dulces, 




Dulcia. 


Gen. Dulcium, 




Dulcium. 


Ace. Dulces, 




Dulcia. 


Abl. Dulcibus 


> 


Dulcibus. 



The exceptions in nominative endings are- 







Singular. 








Masc. and Feju. 


Neut. 


(I) 


Nom. 


Effervescens, 


Effervescens. 




Gen. 


Effervescentis, 


Effervescentis. 




Ace. 


Effervescentem, 


Effervescens. 




Abl. 


Effervescente, or -i 
Plural. 


Effervescente, or 




Nom. 


Effervescentes, 


Effervescentia. 




Gen. 


Effervescentium, 


Effervescentium. 




Ace. 


Effervescentes, 


Effervescentia. 




Abl. 


Effervescentibus, 
Singular. 


Effervescentibus. 


(2) 


Nom. 


Tricolor, 


Tricolor. 




Gen. 


Tricoloris, 


Tricoloris. 




Ace. 


Tricolorem, 


Tricolor. 




Abl. 


Tricolore, or -i, 
Plural. 


Tricolore, or -i. 




Nom. 


Tricolores, 


Tricolora. 




Gen. 


Tricolorum, 


Tricolorum. 




Ace. 


Tricolores, 


Tricolora. 




Abl. 


Tricoloribus, 

Singular. 


Tricoloribus. 






Masc. and Fern. 


Neut. 


(3) 


Nom. 


Fortior, 


Fortius. 




Gen. 


Fortioris, 


Fortioris. 




Ace. 


Fortiorem, 


Fortius. 




Abl. 


Fortiore, or -i, 


Fortiore, or -i. 



X 





PRESCRIPTIONS. 








Phtral. 




Nom 


. Fortiores, Fortiora. 


Gen. 


Fortiorum, Fortiorum. 


Ace. 


Fortiores, Fortiora. 


Abl. 


Fortioribus, Fortioribus. 


Numerals as far 


as qtiatiwr are declined 


like adject 


terminations : 




Singular. 






Masc. 


Fern. 


Neut. 


(i) Nom. 


Unus, 


Una, 


Unum. 


Gen. 


Unius, 


Unius, 


Unius. 


Ace. 


Unum, 


Unam, 


Unum. 


Abl 


Uno, 


Una, 
Plural. 


Uno. 


(2) Nom. 


Dao, 


Duae, 


Duo. 


Gen. 


Duorum 


, Duarum, 


Duorum. 


Ace. 


Duos, 


Duas, 


Duo. 


Abl. 


Duobus, 


Duabus, 
Plural. 


Duobus. 




Masc. 


Fern. 


Neut. 


(3) Nom. 


Tres, 


Tres, 


Tria. 


Gen. 


Trium, 


Trium, 


Trium. 


Ace. 


Tres, 


Tres, 


Tria. 


Abl. 


Tribus, 


Tribus, 


Tribus. 



807 



[The ordinal numbers, primus, secundus, tSrtius, etc., are not 
used in prescription-writing.] 



Conjunctions 

Conjunctions are rare, except et, and. 
employed. 

Prepositions 



Adverbs. 

Adverbs are very seldom 



Three prepositions govern the acaisative case : dd, to, up to ; 
in, into ; and supra, upon. Others are rarely used. 

Two prepositions, oftenest used, govern the ablative case : cUm, 
with, and pro, for. 



8o8 A TEXT-BOOX OF MA TERIA MEDICA. 

Words and Phrases. 

[In the following list accepted usage rather than rigid adherence to Latin quantity has in a few 
instances appeared advisable. One would hardly insist upon settiel, tere, hem, {semmel, terry, benny) 
in place of the customary long vowel sounds, though the former are obviously in accordance with 
Latin prosody.] 

Ad libitum, at pleasure. 

Ad saturdnduni, to saturation. 

A7ia, aa, of each. 

Bene, well, 

Bu, twice. 

Bis indies, twice a day. 

Cibus, food. 

Cochleare medium, a dessertspoon(ful). 

Cochleare magnum, a tablespoon(ful). 

Cochleare pdrvum, a teaspoon(ful). 

Collutorium, a mouth-wash. 

Dei7i, afterward. 

Dimldius, half 

Dosus, a dose. 

Et, and. 

Extende supra, spread upon. 

Gradatim, gradually. 

Gutta, 3. drop. 

Guttdtim, drop by drop. 

Hora, an hour. 

In dies, daily. 

Lagena, a bottle. 

Libra, a pound. 

Linteum, lint. 

Mane, in the morning. 

Mdne pr'imo, early in the morning. 

Mica pdJiis, a breadcrumb. 

Non, not. 

Node, at night. 

Numerus, a number. 

Numero, in number. 

Octdrius, a pint. 

Partes cequdles, in equal parts. 

Pro re ndtd, as required. 

Qudntmn sufficiat, q. s., as much as is necessary. 

Qudqua hora, every hour. 

Saturdtus, saturated. 



PRESCRIPTIONS. 809 

Scdtula, a box. 

Seinel, once. 

Semlssis, ss., a half. 

Semidrachina, half a drachm. 

Slmiil, together. 

Sine, without. 

Stdtiin, immediately. 

Tales, such. 

Tales doses, such doses. 

Tere siimd, rub together. 

Ter in die, three times a day. 

These complete the list of Latin parts of speech, conjugations, 
declensions, etc., with which the prescription-writer is likely to be 
concerned. 

There are niceties of Latin construction which, to one acquainted 
with that idiom, will readily occur in scanning the order of words in 
certain medicinal compounds. Having the sanction of professional 
usage, the departure from the classic arrangement is of sHght 
importance, and it is certainly in accordance with the clearer, more 
direct English form. Instance the construction in what are known 
as " Galenical Preparations " (an objectionable adjective, by the 
way, being at variance with the rules of etymology, since the c of 
the derivative is wanting in the parent word Galen). In writing 
these the nominative — Unguentum, Mistura, Tinctura, etc. — is 
placed first, as, Unguentum Zinci Oxidi, etc. Oleum Morrhuae 
is also an example, and others are not uncommon, apart from the 
Galenical order. 

The practical difficulties in writing prescriptions correctly are 
largely eliminated by the almost exclusive use of the genitive. Yet 
it is necessary to understand clearly the use of the accusative in all 
cases where the medicine is prepared from the mass according to 
certain established formulae, and moulded in certain forms, if not 
already prepared, as in the condition of pills, troches, etc., which 
are the immediate object of the imperative recipe, and cannot be 
placed in the genitive. 

Example : 

^. Pllulas (not Pilularum) Ferri lodidi (a number). 

Where the mass is mentioned or implied in the prescription, the 
general rule of the genitive is followed, as : ]^. Unguenti Bella- 



8lO A TEXT-BOOK OF MA TERIA MEDICA. 

donnae (a portion) ; and where the terms fiat, fiant are expressed^ 
the nominative is naturally used, as, for example, 

^. Massae hydrargyri, gr xxx ; 

Frant pilulae No. x. 
Sig. Take one at bed-time. 

Here pi/ii/cs is the subject of the Latin irregular verb signifying 
"to be made," no case save the nominative being admissible. 

It has been presumed in the foregoing pages that all prescrip- 
tions are to be written in full — a practice which, could it meet with 
universal acceptance, would not infrequently be of vital importance 
alike to patient and practitioner. Custom, however — and in certain 
cases advantageously — has authorized the extensive use oi abbrevia- 
tions^ although the dangers of carelessness or ignorance in their 
employment will be apparent if we consider that, for example, 
Ammo7t. may mean either Ammonia or Ammoniacum ; Chlor.^ 
Chlorum, Chloral, Chloroformum, Chloras, or Chloridum ; Hyd. 
Chlor., Hydrate of Chloral or Hydrargyri Chloridum Corrosivum 
or Mite ; Sulpli., Sulphur, Sulphas, Sulphidum, or Sulphis ; Zinc. 
Phos., Zinci Phosphas or Zinci Phosphidum. 

These are but few of the many instances of ambiguity occa- 
sioned by inadvertence or want of familiarity with the full Latin 
form, or at least its recognized and unmistakable abbreviation. 

In conclusion, let the writer of prescriptions be warned against 
too great haste and a chirography which none but its author can 
decipher — a deficiency for which he alone is responsible, though 
the onus may fall upon the luckless druggist or his bewildered 
clerk. 

With regard to form, it has been our object to show that there 
is really little difficulty in writing good prescription Latin, and 
where the sHghtest chance of error exists the ampler expression, as 
we have strongly urged, should be used. A clear, business-like 
method, deliberately chosen and consistently pursued, will render 
this important item of the physician's labor simple, agreeable, and 
efficient. 

It is necessary not only that the directions to the patient should 
be written in perfectly legible English and in full, but that they 
should contain the exact dose, time for, and method of taking, and, 
in short, every detail which it may be advisable for the patient and 
nurse to know, clearly and intelligibly expressed. A physician is 



PRE SCR IP TIONS. 8 1 1 

seldom justified in writing merely " As directed," the full directions 
being the only clue to the safety of the medicine. Moreover, 
verbal instructions to the patient or attendant may be partially or 
even wholly forgotten, or confounded with directions relating to 
other matters connected with the case, and thus the welfare of the 
patient be endangered. 

All preparations intended for external or local application or for 
injections should be marked accordingly, " For External Use," etc. ; 
and if the agent be a poisonous mixture, a " Not-to-be-taken " label 
should be attached to the bottle. If a mixture is ordered contain- 
ing an insoluble substance, a '* Shake-well " label should be used. 

Should it be necessary to prescribe an extraordinary dose of 
some powerful drug, the name of the remedy should be under- 
scored or attention called to it by a X, referring to the bottom of 
the prescription, where should be written : " Large dose intended," 
or " Dose of above correct," or something to indicate to the phar- 
macist that the writer is fully aware of the unusual amount, and 
thus save delay in consulting with the physician — which a careful 
and competent druggist would otherwise do. Should it, in the 
opinion of the physician, be undesirable to repeat the prescription, he 
should write at the bottom, " Do not repeat," or the customary 
Latin, " Ne repetatur." 

Every prescriber should be supplied with suitable prescription- 
blanks arranged in the form of pads conveniently carried in the 
pocket, a suitable size being four by five inches. The paper should 
be of linen, of good quality ; otherwise it is Hable to become 
detached from the druggist's files and lost. 

It is certainly advisable for the physician to write his prescrip- 
tions invariably in ink, since pencil is easily erased, and a pre- 
scription thus perishable would be of little use in medico-legal 
emergencies. Besides, an unscrupulous druggist who had been 
careless in compounding the remedy might easily change the pencil 
instructions to conform to his mistake. Finally, the pencil-writing 
is always liable to be erased or partially obliterated when carried 
for some time or subjected to frequent handhng. 

The prescription-blank should have printed neatly upon one 
margin or the back the physician's residence and office, together 
with hours for consultation, and telephone number if he has one. 
This advertises the physician to some extent in a legitimate way, 
besides enabling the patient or druggist to communicate with him 
readily if necessary. 



8i2 A TEXT-BOOK OF MATERIA MEDIC A. 

It is a matter of personal taste whether the druggist's name 
should appear upon the blank. Considerations of courtesy and the 
possible event of loss or of legal contingencies may weigh with 
some practitioners, though others are of the opinion that it is un- 
desirable to print anything on the blank save the physician's name, 
office, hours, and telephone number. 

The prescription should always be signed by the writer in full, 
that professional responsibility and identity may be assured, the 
academic *' M. D." being preferable as a title to " Dr.," which is 
applicable to various professions — often of questionable repute and 
authenticity. 

In concluding these practical hints, the author cannot too 
strongly impress upon the student the importance of always writing 
as clear, legible, complete, and classical a prescription as possible. 
In a new community the reputation of the recent graduate is often 
dependent upon the character of the prescription he writes. The 
druggist invariably scans his instructions from the new doctor criti- 
cally, and the laity and the profession will soon learn the young 
aspirant's proficiency or ignorance by his public committal in a pre- 
scription. No matter how able a diagnostician, pathologist, or bac- 
teriologist he may be, if his first effort in prescription-writing be 
illegible, poor Latin or for a hopelessly incompatible mixture, the 
druggist will label, classify, and measure him with the keenness of 
professional insight ; the judgment will go forth quietly ; and years 
of successful practice may not serve to eradicate that first unfavor- 
able impression. 



CLINICAL INDEX. 



Abrasions — 

Isinglass, 783 

Potassium nitrate, 592 

Protectives, 774 
Abscess — 

Calcium phosphate, 208 

Cocaine, 498 

Cod liver oil, 138 

Naphthalin, 324 

Onion poultice, 622 

Phytolacca, 587 

Solution of ammonium acetate, 599 
Acidity of Stomach — 

Alkalies, 164 

Ammonium preparations, 577 
Acne — 

Fowler's solution, 243 

Plydrastine ointment, 487 

Ichthyol, 328 

Phosphorus, 205 

Pyrogallic acid, 715 

Quinine, 218 

Salicylic acid, 318 

Sulphur, 672 
Acne Rosacea — 

Bismuth subnitrate, 753 

Ergot, 483 

Plamamelis, 722 

Ichthyol, 328 

Resorcin, 326 
Aconite-poisoning — 

Atropine, 462 

Digitalis, 547 
Adenitis — 

Camphorated naphtol, 324 

Naphtalin, 324 

Pilocarpine, 597 

Potassium iodide, 254 
After-pains — 

Black haw, 520 

Camphor, 389 
Albuminuria — 

Arsenic, 245 
Alcoholic Tremor — 

Cocaine, 499 
Alcoholism — 

Aromatic spirit of ammonia, 577 

Cocaine, 499 

Coffee, 560 

Solution of ammonium acetate, 599 

Strychnine, 475 



Alcoholism — 

Tincture of lupulin, 447 

Zinc oxide, 737 
Alopecia — 

Aqua ammonise, 577 

Capsicum, 367 

Nutgall ointment, 716 

Pilocarpine, 597 

Quinine, 217 

Savine, 706 

Tannic acid, 714 

Tincture of cantharides, 767 

Turpentine, 645 
Amaurosis — 

Strychnine, 474 
Amblyopia — 

Pilocarpine, 597 
Amenorrhea — 

Aloes, 676 

Ammonium chloride, 619 

Apioline, 709 

Ergot, 482 

Guaiac, 262 

Iron, 198 

Quinine, 218 

Sanguinaria, 268 

Savine, 706 

Senega, 628 

Tansy, 708 

Tincture of cantharides, 767 
Anal Fissure — 

Belladonna ointment, 461 

Bismuth subnitrate, 753 

Chloral, 419 

Cocaine, 498 

Fluid extract of hydrastis, 487 

Geranium, 723 

Glycerin, 776 

Iodoform, ^^^ 

Krameria, 720 

Red rose, 725 

Sulphur, 673 

Tannic acid, 713 

Tincture of iodine, 254 

White oak, 717 

Zinc oxide, 737 
Anemia — 

Arsenic, 244 

Bone marrow, 221 

Cod liver oil, 137 

Copper, 741 

813 



8i4 



CLINICAL INDEX. 



Anemia — 

Digitalis, 545 

Ilypophosphites, 208 

Iron, 197 

Manganese, 200 

Nuclein, 221 

Phosphoric acid, 145 

Potassium chlorate, 353 

Potassium permanganate, 349 

Red wine, 573 

Strychnine, 473 
Aneurysm — 

Digitalis, 547 

Diuretin, 655 

Ergot, 482 

Iodides, 254 

Lead acetate, 733 
Angina Pectoris — 

Allyl tribromide, 622 

Amyl nitrite, 527 

Arsenic, 245 

Cactus, 554 

Chloral, 420 

Compound spirit of ether, 402 

Hydrogen dioxide, 354 

Phosphorus, 205 

Zinc sulphate, 738 
Anginose Scarlatina — 

Sodium sulpliocarbolate, 310 
Anorexa — 

Simple bitters, 180 
Anosmia — 

Strychnine, 472 
Anthrax — 

Serum-therapy, 302 
Aortic Regurgitation — 

Adonidin, 555 

Cactus, 554 

Digitalis, 543 
Apepsia — 

Pepsin, 132 
Aphonia — 

Alum, 750 

Blisters, 763 

Bromides, 535 

Nitric acid, 145 

Potassium bichromate, 351 
Aphthae — 

Borax, 347 

Catechu, 718 

Magnesia, 166 

Red rose, 725 

Rhus glabra, 724 

Saccharine, 658 

Sodium bicarbonate, 164 

Sodium sulphocarbolate, 310 
Apoplexy — 

Croton oil, 686 
Arrhythmia — 

Cactus, 554 

Nitroglycerin, 528 
Arsenical Poisoning — 

Hydrated sesquioxide of iron, 242 

Lime water, 166 



Arsenical Poisoning — 

Magnesia, 246 
Arterio-sclerosis — 

Diuretin, 655 

Nitroglycerin, 528 
Arthritis, Chronic — 

Cod liver oil, 137 
Ascarides — 

Carbolic acid, 309 
Ascites — 

Colchicum, 259 

Colocynth, 692 

Copaiba, 650 

Diuretin, 654 

Elaterin, 687 
Aspergillus — 

Salicylic acid, 318 
Asphyxia — 

Alcohol, 572 

Mustard, 770 
Asthenopia — 

Physostigmine, 514 
Asthma — 

Adonidin, 555 

Allyl tribromide, 622 

Amyl nitrite, 528 

Arsenic, 243 

Belladonna, 461 

Bromides, 535 

Caffeine, 560 

Chloral, 420 

Cocaine, 499 

Colchicum, 259 

Conium, 503 

Grindelia, 509 

Hydrogen dioxide, 354 

Hyoscyamus, 464 

Iodides, 255 

Ipecac, 614 

Lobelia, 616 

Nitre-paper, 593 

Opium, 440 

Physostigma, 515 

Pilocarpnie, 597 

Quinine, 217 

Spartein sulphate, 513 

Stramonium, 463 

Strychnine, 474 

Terpin hydrate, 630 

Zinc oxide, 737 

Zinc sulphate, 738 
Atheroma — 

Cod liver oil, 138 
Aural Catarrh — 

Ammonium chloride, 619 

Belanitis — 

Alumnol, 324 
Silver nitrate, 546 
Bed-sores — 
Alcohol, 571 
Emollients, 774 
Glycerin, 776 
Lead tannate, 734 



CLINICAL INDEX. 



815 



Bed-sores — 

Protectives, 774 

vSilver nitrate, 745 

Tannic acid, 713 
Belladonna-poisoning — 

Pilocarpine, 598 
Biliary Calculi — 

Sodium phosphate, 690 

Turpentine, 646 
Biliousness — 

Calomel, 234 

Citric acid, 151 

Seidlitz powder, 690 

Senna, 684 
Bites of Insects — 

Ammonia water, 577 

Olive oil, 778 

Rhus toxicodendron, 490 
Bites of Rabid Animals — 

Carbolic acid, 308 

Solution of chloride of antimony, 758 

Sulphuric acid, 144 
Bites of Venomous Reptiles — 

Solution of chloride of antimony, 758 
Bladder, Chronic Catarrh of — 

Tincture of cantharides, 767 
Bladder, Debility of— 

Fluid extract of blackberry, 726 

Tincture of cantharides, 767 
Bladder, Paralysis of — 

Arnica, 591 
Bladder, Spasm of — 

Cannabis, 452 
Blepharitis Marginalis — 

Yellow-oxide-of-mercury ointment, 233 
Blepharospasm — 

Conium, 503 
Boils- 
Belladonna ointment, 460 

Cantharidal blister, 766 

Glycerin, 776 

Menthol, 377 

Silver nitrate, 745 

Tar, 626 
Brain, Congestion of — 

Elaterin, 687 
Bright's Disease — 

Alkalies, 165 

Cod liver oil, 138 

Digitalis, 547 

Gallic acid, 715 

Iron, 197 

Pilocarpine, 597 

Scoparius, 553 

Spirit of nitrous ether, 600 

Strophanthus, 551 
Bromidrosis — 

Chloral, 419 

Hydrastine ointment, 487 

Potassium permanganate, 349 
Bronchitis— 

Acetanilid, 393 

Alum, 750 

Ammoniacum, 389 



Bronchitis — 

Ammonium carbonate, 578 
Ammonium chloride, 619 
Ammonium preparations, 166 
Apomorphine, 606 
Arsenic, 243 
Asafetida, 389 
Balsam of tolu, 621 
Benzoic acid, 337 
Buchu, 640 

Burgundy-pitch plaster, 772 
Calomel, 235 
Cannabis, 452 
Catechu, 718 
Codeine, 445 
Cod liver oil, 137 
Colchicum, 259 
Copaiba, 650 
Creosote, 311 
Croton oil, 685 
Demulcents, 774 
Digitalis, 546 
Eucalyptus, 345 
Grindelia, 509 
Hamanielis, 722 
Hedeoma, 710 
Hydrastis, 487 
Hyposulphites, 357 
Iodides, 255 
Iron, 197 
Lime water, 166 
Liquorice, 623 
Lobelia, 616 
Myrrh, 339 
Nitric acid, 145 
Onion poultice, 622 
Opium, 440 
Physostigma, 515 
Sanguinaria, 268 
Senega, 628 
Squill, 638 
Strychnine, 474 
Sulphur, 673 
Syrup of garlic, 622 
Tar, 626 

Tartar emetic, 610 
Terebene, 629 
Terpin hydrate, 630 
Turpentine, 646 
Wild cherry, 180 
Wine of ipecac, 612 
Bronchorrhea — 
Alum, 750 
Asafetida, 389 
Carbolic acid, 308 
Copaiba, 650 
Eucalyptus, 345 
Gallic acid, 715 
Lead acetate, 733 
Myrrh, 339 
Pilocarpine, 597 
Senega, 628 
Terebene, 629 
Turpentine, 646 



;i6 



CLINICAL INDEX. 



Bronchorrhea — 

Zinc oxide, 737 
Bruises — 

.Ammonium chloride, 619 

Arnica, 591 

Camphor liniment, 388 

Hamamelis, 722 

Olive oil, 778 

Potassium nitrate, 592 

Solution of lead subacetate, 733 

Tansy, 708 
Buboes- 
Ammonium chloride, 619 

Hydrogen dioxide, 354 

Iodoform, 332 

Phytolacca, 587 

Salol, 321 

Tincture of iodine, 253 
Buccal Ulcer — 

Geranium, 723 

Red rose, 725 
Burns — 

Acacia, 780 

Bismuth subgallate, 754 

Bismuth subnitrate, 753 

Carbolic acid, 308 

Cocaine ointment, 498 

HamameUs, 722 

Lead carbonate, 734 

Lime water, 164 

Linseed oil, 779 

Menthol, 377 

Nutgall ointment, 716 

Ointment of rose, 725 

Olive oil, 778 

Phytolacca, 587 

Protectives, 774 

Rhus toxicodendron, 490 

Salol, 321 

Sodium bicarbonate, 163 

Terebene, 629 

Zinc oxide, 737 

Calculi- 
Ammonium benzoate, 338 
Callositas — 

Salicylic acid, 317 
Cancer — 

Arsenic, 242 

Bromine, 762 

Calendula, 180 

Carbolic acid, 308 

Conium, 502 

Hydrastine ointment, 487 

Nitrate of sanguinarine, 267 

Podophyllum, 695 

Spermine, 219 

Sulphuric acid, 144 

Zinc chloride, 762 

Zinc sulphate, 738 
Cancer of Cervix — 

Nitric acid, 144 
Cancer of Stomach — 

Arsenic, 245 



Cancer of Stomach — 

Pepsin, 132 
Cancer of Tongue — 

Potassium permanganate, 349 
Cancer of Uterus — 

Arsenic, 245 

Chloral, 418 

Pepsin, 132 

Potassium permanganate, 349 

Tannic acid, 713 
Cancer of Vagina — 

Potassium permanganate, 349 
Cancrum Oris — 

Bismuth subnitrate, 753 

Zinc sulphate, 737 
Capillary Bronchitis — 

Alcohol, 572 

Ammonium iodide, 255 

Serpentaria, 181 

Turpentine, 646 
Carbuncle — 

Belladonna ointment, 460 

Cantharidal blister, 766 

Ergot, 482 

Glycerin, 776 

Hamamelis, 722 

Serum-therapy, 302 
Cardiac Depression — 

Caffeine, 560 
Cardiac Irritability — 

Bromides, 535 
Cardiac Pain — 

Belladonna, 462 
Caries of the Temporal Bone- 
Turpentine, 645 
Catarrh — 

Benzoic acid, 337 

Borax, 347 

Boric acid, 347 

Dobell's solution, 164 

Eucalyptus, 343 

Hydrastis, 487 

Potassium permanganate, 349 

Sodium sulphocarbolate, 310 
Catarrh of Stomach- 
Capsicum, 367 
Cellulitis — 

Digitalis, 546 
Cerebral Anemia — 

Phosphorus, 205 
Cerebral Hemorrhage — 

Phosphorus, 205 
Cerebral Hyperemia — 

Belladonna, 462 

Colchicum, 259 

Ergot, 483 
Cerebro-spinal Meningitis — > 

Aconite, 582 

Alcohol, 572 

Blisters, 763 

Ergot, 483 

Gelsemium, 507 
Cerumen, Impacted — 

Glycerin, 776 



CLINICAL INDEX. 



817 



Cerumen, Impacted — 

Liquor potassa?, 163 

Papain, 134 
Cervix, Erosion of — 

Glycerin, 776 
Chafing of the Skin — 

Lycopodium, 783 
Chancre — 

Acetanilid, 392 

Alumnol, 324 

Bismuth benzoate, 337 

Bismuih subnitrate, 753 

Fluid extract of hydrastis, 487 

Iodoform, 332 

Solution of chloride of antimony, 758 

Sulphuric acid, 144 
Chancroid — 

Acetanilid, 392 

Bismuth benzoate, T^y] 

Carbolic acid, 308 

Fluid extract of hydrastis, 487 

Iodoform, 332 

Potassium bichromate, 351 

Salicylic acid, 317 

Silver nitrate, 745 
Chapping — 

Bismuth subnitrate, 753 

Camphor ice, 388 

Compound tincture of benzoin, 337 

Glycerin, 776 

Ointment of rose, 725 

Tragacanth, 782 
Chilblain— 

Aconite, 581 

Alum, 750 

Ammonia liniment, 577 

Camphor liniment, 388 

Capsicum, 367 

Carbolic acid, 308 

Nutgall ointment, 716 

Rhus toxicodendron, 490 
Chills— 

Strophanthus, 551 
Chloasma — 

Xitric acid, 144 

Tincture of iodine, 254 
Chloroform -poisoning — 

Ammonia, 577 

Amyl nitrite, 528 

Atropine, 462 

Strychnine, 475 
Chlorosis — 

Aloes, 676 

Arsenic, 245 

Hypophosphites, 208 

Iron, 197 

Manganese, 200 

Potassium chlorate, 353 

Red wine, 573 

Strychnine, 473 
Cholera — 

Bismuth subnitrate, 754 

Calomel and opium, 235 

Camphor, 389 
52 



Cholera — 

Chloral, 420 

Opium, 440 

SaUcylic acid, 319 

Salol, 321 

Serum-therapy, 297 

Sulphur, 673 

Sulphuric acid, 146 
Cholera Infantum — 

Bismuth subnitrate, 754 

Lead acetate, 733 
Cholera Morbus — 

Chloral, 420 

Opium, 440 

Salol, 321 
Chordee — 

Camphor, 388 

Cannabis, 452 

Colchicum, 259 

Hop poultice, 447 

Monobromated camphor, 389 
Chorea — 

Acetanilid, 393 

Arsenic, 244 

Asafetida, 389 

Cerium oxalate, 755 

Chloral, 419 

Cocaine, 499 

Conium, 503 

Copper sulphate, 741 

Curare, 517 

Exalgine, 397 

Gelsemium, 506 

Hyoscine, 466 

Iron, 197 

Opium, 440 

Physostigma, 515 

Picrotoxin, 477 

Quinine, 217 

Salicylic acid, 318 

Silver nitrate, 746 

Spermine, 219 

vStrychnine, 474 

Zinc oxide, 737 

Zinc sulphate, 738 
Cinchonism — 

Diluted hydrobromic acid, 536 
Cirrhosis of Kidneys — 

Potassium iodide, 255 
Cirrhosis of Liver — 

Calomel, 234 

Iodoform, ^I'i'S 

Potassium iodide, 255 
Colchicum-poisoning — 

Potassium permanganate, 350 
Colds- 
Aconite, 581 

Citric acid, 151 

Fluid extract of pilocarpus, 598 

Mustard bath, 770 
Colic- 
Belladonna, 462 

Chloral, 419 

Ginger, 374 



8i. 



CLINICAL INDEX. 



Colic— 

Hedeoma, 710 

Hyoscyamus, 466 

Tansy, 708 
Collapse — 

Alcohol, 572 

Digitalis, 545 
Coma — 

Mustard, 770 
Comedo — 

Salicylic acid, 318 

Sulphur, 672 
Condylomata — 

Chromic acid, 758 

Copper sulphate, 740 

Resorcin, 326 

Solution of chloride of antimony, 75^ 
Congestion of Lungs — 

Ergot, 483 
Congestive Chill — 

Opium, 440 
Conjunctivitis — 

Alum, 750 

Bismuth subnitrate, 753 

Boric acid, 347 

Copper sulphate, 740 

Gallicine, 715 

Hydrastine hydrochlorate, 487 

Morphine sulphate, 440 

Nitrate of sanguinarine, 267 

Silver nitrate, 745 

Zinc acetate, 737 

Zinc sulphate, 737 
Constipation — 

Aloes, 676 

Arsenic, 245 

Asafetida, 388 

Belladonna, 461 

Cascara sagrada, 669 

Cassia fistula, 666 

Castor oil, 668 

Colocynth, 692 

Euonymus, 680 

Glycerin, 777 

Hydrastine, 487 

Jalap, 693 

Magnesia, 670 

Magnesium carbonate, 670 

Manna, 671 

Oxgall, 677 

Physostigma, 515 

Podophyllum, 695 

Rhubarb, 679 

Senna, 684 

Sodium salts, 690 

Strychnine, 473 

Sulphur, 673 

Taraxacum, 674 
Contusions — 

Alcohol, 571 

Calendula, 180 

Solution of ammonium acetate, 599 
Convalescence — 

Alcohol, 571 



Convalescence — 

Cod liver oil, 138 

Simple bitters, 180 

Wine of coca, 499 
Convulsions — 

Chloral, 419 
Corneal Ulcer — 

Physostigmine, 514 
Corns — 

Acetic acid, 150 

Arsenic, 242 

Glacial acetic acid, 761 

Potassium bichromate, 351 

Salicylic acid, 317 
Corrosive Poisoning — 

Olive oil, 778 
Coryza — 

Ammonium chloride, 619 

Antipyrine, 394 

Arsenic, 245 

Camphor, 388 

Camphoric acid, 389 

Cocaine, 498 

Dover's powder, 441 

Gelsemium, 507 

Glycerin, 776 

Iodine, vapor of, 254 

Oil of Scotch fir, 624 

Salicylic acid, 318 

Solution of ammonium acetate, 599 

Whiskey, 573 
Cough — 

Apomorphine, 606 

Benzoic acid, 337 

Bromides, 534 

Cannabis, 452 

Cerium oxalate, 755 

Coniine, 503 

Cubeb, 653 

Geranium, 723 

Grindelia, 509 

Hydrocyanic acid, 524 

Ipecac, 612 

Lactucarium, 448 

Linseed tea, 779 

Liquorice, 623 

Spirit of nitrous ether, 600 

Strychnine, 474 

Sumbul, 519 

Terebene, 629 

Turpentine, 646 
Cracked Nipples — 

Bismuth subnitrate, 753 

Brandy, 571 

Chloral, 419 

Compound tincture of benzoin, 337 

White oak, 717 
Cretinism — 

Thyroid extract, 220 
Croup — 

Alum, 750 

Ipecac, 613 

Lactic acid, 148 

Papain, 134 



CLINICAL INDEX. 



819 



Croup — 

Pepsin, 132 

Senega, 628 

Silver nitrate, 745 

Tartar emetic, 610 

Zinc sulphate, 738 
Crusts, Removal of — 

Olive oil, 778 
Cuts- 
Isinglass, 783 
Cystitis — 

Antipyrine, 394 

Belladonna, 462 

Benzoic acid, 337 

Boric acid, 347 

Buchu, 640 

Camphoric acid, 389 

Copaiba, 650 

Demulcents, 774 

Elm, 781 

Gallic acid, 715 

Hamamelis, 722 

Hydrogen dioxide, 354 

Hyoscyamus, 466 

Lactic acid, 148 

Myrrh, 339 

Piperazin, 657 

Quinine, 217 

Resorcin, 326 

Saccharin, 658 

Salol, 321 

Turpentine, 646 

Deafness — 

Iodine, vapor of, 254 
Deglutition, Painful — 

Olive oil, 778 
Delirium of Fevers — 

Diluted hydrobromic acid, 536 
Delirium Tremens — 

Arnica, 591 

Aromatic spirit of ammonia, 577 

Bromides, 535 

Bromoform, 536 

Camphor, 389 

Chamomile, l8o 

Digitalis, 546 

Hyoscine, 466 

Strychnine, 474 

Tincture of lupulin, 447 

Zinc oxide, 737 
Dementia — 

Eucalyptus, 343 

Hyoscine, 466 
Dermatitis — 

Ichthyol, 328 

Magnesium carbonate, 164 

"White oak, 717 
Diabetes Insipidus — 

Ergot, 483 

Gallic acid, 715 

Lime water, 166 

Pilocarpine, 598 

Tincture of cantharides, 767 



Diabetes Insipidus — 

Valerian, 390 
Diabetes Mellitus — 

Alum, 750 

Ammonium bromide, 535 

Antipyrine, 394 

Arsenic, 245 

Cod liver oil, 138 

Extract of pancreas, 222 

Glycerin, 777 

Guaiacol, 314 

Hydrogen dioxide, 354 

Iodoform, 112) 

Iron, 198 

Lactic acid, 148 

Phosphoric acid, 146 

Piperazin, 657 

Saccharin, 658 

Strychnine, 475 

Thymol, 379 

Valerian, 390 
Diarrhea — 

Alum, 750 

Arnica, 591 

Arsenic, 244 

Bismuth phosphate, 754 

Bismuth subgallate, 754 

Bismuth subnitrate, 754 

Bismuth tannate, 754 

Borax, 348 

Boric acid, 348 

Brandy, 572 

Bromides, 534 

Caffeine, 560 

Camphor, 389 

Catechu, 718 

Cerium oxalate, 755 

Chalk mixture, 166 

Colchicum, 259 

Copaiba, 650 

Copper sulphate, 741 

Demulcents, 774 

Digitalis, 546 

Elm, 781 

Ergot, 483 

Erythrophleum, 639 

Eucalyptus, 343 

Fluid extract of blackberry, 726 

GaUic acid, 715 

Ginger, 374 

Hamamelis, 722 

Hematoxylon, 721 

Hope's camphor mixture, 145 

Hydronaphtol, 324 

Infusion of nutgall, 716 

Ipecac, 613 

Iron, 198 

Kino, 719 

Krameria, 720 

Lactic acid, 148 

Lead acetate, 733 

Lime water, 166 

Pepsin, 132 

Prepared chalk, 166 



820 



CLINICAL INDEX. 



Diarrhea. 

Quinine, 217 

Resorcin, 327 

Rhubarb, 679 

Salicylic acid, 319 

Salol, 321 

Sodium nitrate, 593 

Sodium sulphocarbolate, 3 10 

Strychnine, 473 

Sulphuric acid, 146 

Tannic acid, 714 

Thymol, 379 

White oak, 717 

Zinc oxide, 737 

Zinc sulphate, 738 

Zinc sulphocarbolate, 310 
Digestive Disorders — 

Nuclein, 221 
Digestive Organs, Inflamed Condi- 
tions of — 

Althaea, 781 
Dilatation of Heart — 

Digitalis, 544 

Ergot, 482 
Dilatation of Stomach — 

Carbolic acid, 309 

Physostigma, 515 
Diphtheria — 

Alcohol, 572 

Alum, 750 

Balsam of tolu, 621 

Bichloride of mercury, 235 

Chloral, 419 

Chlorine water, 358 

Eucalyptus, 343 

Gallic acid, 714 

Hydrochloric acid, 144 

Hydronaphtol, 324 

Hyposulphites, 357 

Ipecac, 613 

Iron, tincture of chloride of, 196 

Lactic acid, 148 

Papain, 134 

Pepsin, 132 

Potassium permanganate, 349 

Resorcin, 326 

Salicylic acid, 318 

Serum-therapy, 285 

Sodium sulphocarbolate, 310 

Sulphur, 673 

Sulphurous acid, 355 

Tartaric acid, 15 1 

Thymol, 379 

Turpentine, 646 

Zinc sulphate, 738 
Diphtheritic Paralysis — 

Strychnine, 474 
Dropsy — 

Caffeine, 560 

Copaiba, 650 

Digitalis, 547 

Diuretin, 654 

Iris, 681 

Jalap, 693 



Dropsy — 

Juniper, 642 

Potassium bitartrate, 165 

Potassium iodide, 255 

Salines, 690 

Solution of ammonium acetate, 599 

Squill, 638 
Dryness of Mouth — 

Glycerin, 776 
Duodenal Catarrh — 

Salol, 321 

Sanguinaria, 268 

Sodium phosphate, 690 
Dysentery — 

Acacia, 780 

Alum, 750 

Arnica, 591 

Bismuth phosphate, 754 

Bismuth subgallate, 754 

Bismuth subnitrate, 754 

Carbolic acid, 309 

Colchicum, 259 

Copaiba, 650 

Copper sulphate, 741 

Corrosive chloride of mercury, 234 

Demulcents, 774 

Elm, 781 

Ergot, 483 

Erythrophleum, 639 

Gallic acid, 715 

Geranium, 723 

Hamamelis, 722 

Hematoxylon, 721 

Hydronaphtol, 324 

Infusion of nutgall , 716 

Ipecac, 613 

Iron, 198 

Kino, 719 

Krameria, 720 

Lactic acid, 148 

Lead acetate, 733 

Lime water, 166 

Olive oil, 778 

Opium, 217 

Quinine, 217 

Rhubarb, 679 

Silver nitrate, 746 

Sodium nitrate, 593 

Tannic acid, 714 

Thymol, 379 

White oak, 717 

Zinc oxide, 737 

Zinc sulphate, 738 
Dysmenorrhea — 

Acetanilid, 393 

Ammonium chloride, 619 

Amyl nitrate, 528 

Apioline, 709 

Arsenic, 243 

Black haw, 520 

Camphor, 389 

Cannabis, 452 

Caulophyllum, 707 

Croton oil, 685 



CLINICAL INDEX. 



821 



Dysmenorrhea — 

Ergot, 482 

Gelsemium, 507 

Guaiac, 262 

Hamamelis, 722 

Hydrastine, 488 

Picrotoxin, 478 

Sanguinaria, 268 

Solution of ammonium acetate, 599 

Spirit of nitrous ether, 600 

Sumbul, 519 
Dyspepsia — 

Alcohol, 571 

Alkalies, 164 

Ammonium preparations, 166 

Asafetida, 388 

Bismuth phosphate, 754 

Carbolic acid, 309 

Cerium oxalate, 755 

Colchicum, 259 

Erythrophleum, 639 

Hematoxylon, 721 

Hops, 447 

Hydrochloric acid, 144 

Hydrocyanic acid, 524 

Ipecac, 613 

Lactic acid, 148 

Manganese sulphate, 200 

Myrrh, 339 

Pepsin, 132 

Potassium bichromate, 351 

Quinine, 218 

Resorcin, 327 

Simple bitters, 180 

Sodium sulphocarbolate, 310 

Strontium bromide, 535 

Strychnine, 472 

Sulphurous acid, 356 

Taraxacum, 674 

Terebene, 629 

Xanthoxylum, 271 

Zinc sulphate, 738 
Dysphonia — 

Bromides, 535 
Dyspnea — 

Amyl nitrite, 528 

Aspidosperma, 518 

Bromides, 535 

Grindelia, 509 

Hydrogen dioxide, 354 

Ear, Diseases of — 

Aristol, 333 
Calendula, 180 
Ichthyol, 328 



lodofov 



!3 



163 



Liquor potassse. 
Nitric acid, 144 
Sodium bicarbonate, 1 64 
Earache — 
Hops, 447 
Oil of cloves, 370 
Onion, 622 



Ecchymoses — 

Arnica, 591 
Eclampsia, Infantile — 

Picrotoxin, 477 
Ecthyma — 

Quinine, 218 

Solution of lead subacetate, 733 

Sulphur, 672 
Eczema — 

Anderson's powder, 388 

Arsenic, 243 

Belladonna, 461 

Bismuth subgallate, 754 

Black wash, 164 

Calomel, 233 

Carbolic acid, 308 

Cod liver oil, 137 

Coffee, 560 

Colchicum, 259 

Eucalyptus, 343 

Fluid extract of pilocarpus, 597 

Galla, 716 

Gallicine, 715 

Gelsemium, 507 

Glycerite of starch, 756 

Grindelia, 509 

Hamam.elis, 722 

Hydrocyanic acid, 524 

Ichthyol, 328 

Lead acetate, 732 

Lead iodide, 734 

Lycopodium, 783 

Menthol, 377 

Papain, 134 

Phytolacca, 587 

Potassium chlorate, 353 

Prepared chalk, 164 

Resorcin, 326 

Rhus toxicodendron, 490 

Salicylic acid, 317 

Salol, 321 

Sodium carbonate, 164 

Solution of lead subacetate, 733 

Sulphur, 672 

Tannic acid, 713 

Tar, 626 

Yellow wash, 164 

Zinc carbonate, 738 

Zinc oxide, 737 

Zinc sulphate, 738 
Edema of the Prepuce — 

Glycerin, 776 
Emphysema — 

Physostigma, 515 

Terebene, 629 

Turpentine, 646 
Empyema — 

Hydrogen dioxide, 354 

Tincture of iodine, 254 
Endarteritis — 

Iodides, 254 

Mercury, 234 



822 



CLINICAL INDEX. 



Endocarditis — 

Blisters, 763 

Carbolic acid, 308 

Quinine, 217 
Endometritis — 

Carbolic acid, 308 

Glycerite of tannic acid, 776 

Hydrogen dioxide, 354 

Solution of zinc chloride, 762 

Tincture of iodine, 254 
Enlarged Tonsils — 

Chromic acid, 758 

Zinc sulphate, 737 
Enteralgia — 

Belladonna, 461 

Hyoscyaraus, 466 
Enteritis — 

Demulcents, 774 

Hamamelis, 722 
Enterocolitis — 

Salicylic acid, 319 
Enuresis — 

Camphoric acid, 389 

Rhus glabra, 725 
Epididymitis — 

Ammonium chloride, 619 

Mercurial ointment, 233 

Silver nitrate, 745 
Epilepsy — 

Acetanilid, 393 

Amyl nitrite, 528 

Borax, 348 

Brain-extract, 221 

Bromides, 534 

Chloral, 420 

Coniine hydrobromate, 503 

Copper sulphate, 741 

Curare, 517 

Digitalis, 546 

Hydrastine hydrochlorate, 488 

Hydrogen dioxide, 354 

Phosphorus, 205 

Physostigma, 515 

Picrotoxin, 477 

Silver nitrate, 746 

Strychnine, 474 

Zinc oxide, 737 

Zinc sulphate, 738 
Epistaxis — 

Acetanilid, 392 

Acetic acid, 150 

Alum, 749 

Arnica, 591 

Digitalis, 546 

Ether, 402 

Geranium, 723 

Hamamelis, 722 

Kino, 719 

Krameria, 720 

Sulphuric acid, 144 
Epithelioma — 

Arsenic, 245 

Bismuth subnitrate, 753 

Ergot, 482 



Epithelioma — 

. Lead nitrate, 734 

Nitric acid, 144 

Pyrogallol, 715 

Zinc chloride, 762 
Erysipelas- 
Alcohol, 573 

Belladonna, 462 

Bismuth subnitrate, 753 

Carbolic acid, 308 

Fluid extract of pilocarpus, 597 

Glycerin, 777 

Gualacol, 314 

Hyposulphites, 357 

Ichthyol, 328 

Iron, 198 

Lead carbonate, 734 

Lycopodium, 783 

Pilocarpine, 597 

Prepared chalk, 164 

Quinine, 217 

Rhus toxicodendron, 490 

Salicylic acid, 317 

Solution of lead subacetate, 733 

Tannic acid, 713 

Turpentine, 646 

Zinc oxide, 737 
Erythema— 

Anderson's powder, 388 

Bismuth subnitrate, 753 

Ergot, 483 

Hamamelis, 722 

Hydrocyanic acid, 524 

Ichthyol, 328 

Lead acetate, 732 

Rhus toxicodendron, 490 
Exanthemata — 

Acetanilid, 392 

Acetic acid, 150 

Ammonium carbonate, 577 

Ammonium chloride, 619 

Camphor, 389 

Cod-liver oil, 137 

Opium, 442 

Solution of ammonium acetate, 597 
Excoriations — 

Acacia, 780 

Glycerin, 776 

Olive oil, 778 

Protectives, 774 

Tar, 626 
Exophthalmic Goiter- 
Belladonna, 462 

Bromides, 535 

Digitalis, 545 

Ergot, 483 

Thyroid extract, 220 
Eye, Diseases of — 

Fluid extract of red rose, 725 

Iodoform, 333 

Physostigmine, 514 

Fainting — 

Ammonia water, 577 



CLINICAL INDEX. 



823 



Fainting — 

Cubeb, 653 
Fatty Heart — 

Caffeine, 560 
Fauces, Inflammation of — 

Salicylic acid, 318 
Favus — 

Carbolic acid, 308 

Gallanol, 715 

Hyposulphites, 357 

Phytolacca, 587 
Febrile Affections — 

Acacia, 780 

Acetanilid, 392 

Aconite, 581 

Ammonium carbonate, 577 

Citric acid, 15 1 

Demulcents, 774 

Hydrochloric acid, 145 

Opium, 441 

Potassium nitrate, 593 

Sodium bromide, 535 

Spirit of nitrous ether, 600 

Tartar emetic, 610 
Felons — 

Chloral, 419 

Cocaine, 498 

Silver nitrate, 745 

Solution of lead subacetate, 733 
Fermentation — 

Salicylic acid, 319 
Fissured Nipples — 

Galla, 716 

Glycerin, 776 

Lead nitrate, 734 

Tar, 626 

Zinc oxide, 737 
Fistula- 
Calcium phosphate, 208 

Cantharidal blister, 766 

Cod liver oil, 138 

Hydrogen dioxide, 354 

Iodoform, -^^-^T} 
Fistulous Discharges — 

Quinine, 217 
Fistulous Openings, to Dilate — 

Elm, 781 
Flatulence — 

Anise, 362 

Asafetida, 388 

Brandy, 572 

Camphor, 389 

Compound spirit of ether, 402 

Ginger, 374 

Glycerin, 777 

Hops, 447 

Physostigma, 515 

Salicylic acid, 319 

Spirit of nitrous ether, 600 

Turpentine, 646 
Freckles — 

Haraamelis, 722 

Potassium nitrate, 593 



Frost-bite- 
Alcohol, 571 

Compound tincture of benzoin, 337 
Hamamelis, 722 

Galactorrhea — 

Ergot, 483 
Gall-stones — 

Olive oil, 778 
Gangrene — 

Ammonium chloride, 619 

Bromine, 762 

Carbolic acid, 308 

Hematoxylon, 721 

Lead nitrate, 734 

Nitric acid, 144 

White oak, 717 
Gangrene of Lungs — 

Carbolic acid, 308 

Eucalyptus, 345 

Hyposulphites, 357 

Salicylic acid, 318 
Gangrene of Pharynx — 

Alum, 749 

Copper sulphate, 740 
Gangrenous Sores — 

Solution of chlorinated soda, 359 
Gastralgia — 

Acetanilid, 393 

Arsenic, 244 

Belladonna, 461 

Bismuth phosphate, 754 

Brandy, 572 

Coca, 499 

Compound spirit of ether, 402 

Manganese dioxide, 200 

Menthol, 377 

Resorcin, 326 

Silver nitrate, 746 

Silver oxide, 746 

Zinc oxide, 737 
Gastric Acidity — 

Glycerin, 777 
Gastric Catarrh — 

Iodoform, 333 

Salicylic acid, 319 

Simple bitters, 180 

Strychnine, 473 
Gastric Fermentation — 

Hyposulphites, 357 

Potassium permanganate, 349 
Gastric Pain — 

Cantharidal blister, 767 

Hydrocyanic acid, 524 
Gastric Ulcer — 

Arsenic, 245 

Bismuth subnitrate, 754 

Lead acetate, 733 

Manganese dioxide, 200 

Potassium bichromate, 351 

Silver nitrate, 746 

Silver oxide, 746 
Gastritis — 

Acacia, 780 



824 



CLINICAL INDEX. 



Gastritis — 

Arsenic, 244 

Bismuth subnitrate, 754 

Demulcents, 774 

Lead acetate, 733 

Resorcin, 327 

Silver nitrate, 746 
Gastrodynia — 

Codeine, 445 
General Debility — 

Digitalis, 545 
Gingivitis — 

Borax, 347 

Boric acid, 347 

Hydronaphtol, 324 
Glandular Enlargements — . 

Ammonium chloride, 619 

Solution of ammonium acetate, 599 
Gleet — 

Alum, 750 

Buchu, 640 

Copaiba, 650 

Copper sulphate, 740 

Geranium, 723 

Krameria, 720 

Lead acetate, 732 

Tar water, 626 

Tincture of cantharides, 767 

Turpentine, 646 
Glossitis — 

Chromic acid, 759 
Goiter- 
Ammonium chloride, 619 

Carbolic acid, 308 

Red-iodide-of-mercury ointment, 234 

Tincture of iodine, 254 
Gonorrhea — 

Acetic acid, 150 

Alum, 750 

Alumnol, 324 

Argonin, 746 

Bismuth subnitrate, 753 

Bismuth tannate, 754 

Boric acid, 347 

Buchu, 640 

Cannabis, 452 

Catechu, 718 

Chloral, 418 

Chromic acid, 759 

Colchicum, 259 

Copaiba, 650 

Copper sulphate, 740 

Geranium, 723 

Glycerin, 776 

Grindelia, 509 

Hamamelis, 722 

Hydrastin, 486 

Hydrogen dioxide, 354 

Kino, 719 

Lead acetate, 732 

Oil of santal, 650 

Potassium permanganate, 349 

Quinine bisulphate, 217 

Resorcin, 326 



Gonorrhea — 

Salol, 321 

Silver nitrate, 745 

Sodium sulphocarbolate, 310 

Solution of zinc chloride, 762 

Tannic acid, 713 

Turpentine, 646 

Zinc acetate, 737 

Zinc sulphate, 737 
Gout — 

Alkahes, 164 

Arnica, 591 

Colchicum, 259 

Guaiac, 262 

Lactic acid, 148 

Lithium carbonate, 164 

Piperazin, 657 

Potassium iodide, 255 

Salicylic acid, 318 

Tincture of iodine, 253 
Gouty Diathesis — 

Lithium preparations, 166 - 

Sodium salts, 690 
Gouty Sores — 

Piperazin, 657 
Granular Lids — 

Bismuth subnitrate, 753 
Granulations — 

Alum, 749 

Nitric acid, 144 
Gummata — 

Iodides, 254 

Hay Fever — 

Ammonium iodide, 255 

Arsenic, 245 

Cannabis, 452 

Cocaine, 498 

Grindelia, 509 

Quinine, 217 

Resorcin, 326 

Terpin hydrate, 630 
Headache — 

Acetanilid, 393 

Aromatic spirit of ammonia, 577 

Arsenic, 244 

Bromides, 534 

Butyl-chloral hydrate, 424 

Caffeine, 560 

Cannabis, 452 

Cubeb, 653 

Ergot, 483 

Menthol, 377 

Quinine, 217 

Salicylic acid, 318 

Spirit of nitrous ether, 600 

Valerian, 390 
Heart, Fatty Degeneration of — 

Iodine, 255 
Heart, Functional Disorders of — 

Cactus, 554 
Heart, Functional Irregularity of- 

Adonidin, 555 

Strychnine, 473 



CLINICAL INDEX. 



825 



Heart, Valvular Diseases of — 

Iodine, 255 
Hebephrenia — 

Brain extract, 222 
Hematemesis — 

Alum, 750 

Gallic acid, 714 

Hamamelis, 722 

Ipecac, 613 

Iron, 198 

Krameria, 720 

Sulphuric acid, 146 

Tannic acid, 714 

Turpentine, 646 
Hematuria — 

Alum, 750 

Hamamelis, 722 

Krameria, 720 

Piperazin, 657 

Rhus glabra, 724 

Turpentine, 646 
Hemiplegia — 

Strychnine, 474 
Hemoptysis — 

Acetaniiid, 392 

Arnica, 591 

Digitalis, 546 

Fluid extract of hydrastis, 488 

Gallic acid, 714 

Gelsemium, 507 

Geranium, 723 

Hamamelis, 722 

Iodoform, 333 

Ipecac, 614 

Krameria, 720 

Lead acetate, 733 

Tannic acid, 714 

Turpentine, 646 

White oak, 717 
Hemorrhage — 

Alcohol, 572 

Alum, 749 

Digitalis, 545 

Ergot, 483 

Geranium, 723 

Hamamelis, 722 

Iron, 198 

Lead acetate, 733 

Opium, 441 

Pyrogallol, 715 

Turpentine, 646 
Hemorrhage, Intestinal — 

Gallic acid, 714 

vSulphuric acid, 146 
Hemorrhage, Renal — 

Gallic acid, 714 
Hemorrhage Uterine — 

Nitric acid, 144 

Sulphuric acid, 146 
Hemorrhoids — 

Belladonna ointment, 461 

Chromic acid, 759 

Cocaine, 498 

Ergot, 482 



Hemorrhoids — 

Galla, 716 

Gallic acid, 714 

Hamamelis, 722 

Iodoform, 333 

Krameria, 720 

Lead acetate, 732 

Manna, 671 

Menthol, 377 

Nitric acid, 144 

Potassium bromide, 534 

Rhubarb, 679 

Stramonium ointment, 464 

Sulphur, 673 

Tannic acid, 713 

White oak, 717 
Hepatic Cirrhosis — 

Podophyllum, 695 
Hepatic Congestion — 

Calomel, 234 

Gamboge, 687 

Taraxacum, 674 
Hepatic Disorders — 

Nitric acid, 145 
Hepatitis — 

Calomel, 235 
Hernia — 

Caffeine, 560 

Fluid extract of white oak, 717 
Herpes — 

Aconite, 581 

Bismuth subgallate, 754 

Galla, 716 

Hamamelis, 722 

Ichthyol, 328 

Lycopodium, 783 

Rhus toxicodendron, 490 

Salicylic acid, 318 

Tannic acid, 714 
Herpes of Buccal Cavity — 

Potassium chlorate, 353 
Hiccough — 

Chloral, 420 

Coffee, 560 

Compound spirit of ether, 402 
' Infusion of mustard, 770 

Nitroglycerin, 529 

Pilocarpine, 597 
Hoarseness — 

Borax, 347 

Boric acid, 347 

Compound tincture of benzoin, 337 

Cubeb, 653 

Licorice, 623 

Potassium bichromate, 351 
Hodgkin's Disease — 

Arsenic, 243 
Hydrocele — 

Chloral, 418 

Tincture of iodine, 254 
Hydrocyanic- Acid-poisoning — 

Ammonia, 577 

Potassium permanganate, 350 



826 



CLINICAL INDEX. 



Hydrophobia — 

Coniine, 503 

Curare, 517 

Hydrastine hydrochlorate, 488 

Opium, 440 
Hydrothorax — 

Cantharidal blisters, 766 
Hyperidrosis — 

Chloral, 419 

Chromic acid, 759 

Hamamelis, 722 

Hydrastine ointment, 487 

Tannic acid, 713 
Hyperpyrexia, Rheumatic — 

Salicylic acid, 318 
Hypertrophy of Heart- 
Aconite, 581 

Lead acetate, 733 
Hypochondria — 

Arsenic, 245 

Colchicum, 259 

Diluted nitrohydrochloric acid, 145 

Valerian, 390 
Hysteria — 

Allyl tribromide, 622 

Asafetida, 388 

Belladonna, 461 

Brain-extract, 221 

Compound spirit of ether, 402 

Copper sulphate, 741 

Oil of rue, 707 

Sanguinaria, 268 

Sumbul, 519 

Tansy, 708 

Valerian, 390 

Zinc oxide, 737 

Zinc sulphate, 738 
Hysterical Convulsions — 

Hyoscine, 466 
Hysterical Paralysis — 

Blisters, 763 

Ileo-colitis — 

Calomel, 234 

Gray powder, 234 
Impetigo — 

Hyposulphites, 357 

Lead acetate, 732 

Quinine, 218 

Salicylic acid, 317 

Sulphur, 672 

Tannic acid, 713 
Impotence — 

Alcohol, 573 

Cannabis, 453 

Phosphorus, 205 

Sanguinaria, 268 

Tincture of cantharides, 767 
Incontinence of Urine — 

Ammonium benzoate, 338 

Belladonna, 461 

Buchu, 640 

Ergot, 483 

Hyoscyamus, 466 



Incontinence of Urine — 

Iron, 198 

Krameria, 720 

Rhus glabra, 724 

Rhus toxicodendron, 490 

Tincture of cantharides, 767 

Tincture of nux vomica, 472 

Turpentine, 646 
Indigestion — 

Bromides, 534 

Hydrochloric acid, 145 
Infantile Convulsions — 

Allyl tribromide, 622 

Asafetida, 388 

Bromides, 534 

Chloral, 419 

Conium, 503 

Physostigma, 515 
Inflamed Gums — 

Hamamelis, 724 
Inflammation of Nose — 

Carbolic acid, 308 
Inflammation of Throat — 

Carbolic acid, 308 
Inflammations^— 

Hop poultice, 447 

Linseed poultice, 779 

Mercury, 234 
Inflammatory Exudates, to Hasten 
Absorption of — 

Rubefacients, 771 
Influenza — 

Acetanilid, 393 

Salicylic acid, 319 

Serum-therapy, 300 

Solution of ammonium acetate, 599 
Ingrowing Toe-nail — 

Alum, 750 

Liquor potass98, 163 
Insanity — 

Hyoscine, 466 

Sulphonal, 427 

Thyroid extract, 220 
Insomnia — 

Bromides, 534 

Chloral, 419 

Chloral formamide, 423 

Convallaria, 556 

Hyoscine, 466 

Opium, 440 

Paraldehyde, 428 

Phosphorus, 205 
Intermittent Fever — 

Ammonium chloride, 619 

Antipyrine, 394 

Arsenic, 244 

Erythrophleum, 639 

Hydrastine, 487 

Ipecac, 614 

Nitric acid, 145 

Phenocoll, 396 

Quinine, 218 

Resorcin, 327 

Salicylic acid, 318 



CLINICAL INDEX. 



827 



Intertrigo— 

Bismuth subnitrate, 753 

Lead carbonate, 734 

Lycopodium, 783 

Tannic acid, 713 

Zinc carbonate, 738 

Zinc oxide, 737 
Intestinal Catarrh — 

Copaiba, 650 

Salol, 321 

Turpentine, 646 
Intestinal Dilatation — 

Physostigma, 515 
Intestinal Fermentation — 

Oxgall, 677 

vSulphurous acid, 356 
Intestinal Hemorrhage — 

Alum, 750 

Hematoxylon, 721 

Krameria, 720 

Tannic acid, 714 
Intestinal Obstruction — 

Croton oil, 686 
Intestinal Torpor — 

Picrotoxin, 477 
Intestinal Ulcerations — 

Silver nitrate, 746 
Irido-choroiditis — 

Salicylic acid, 318 
Iritis — 

Calomel, 235 
Irritable Conditions of the Heart- 
Hydrocyanic acid, 524 

Strophanthus, 551 
Irritation, Relief of — 

Cod-liver oil, 137 

Jaborandi-poisoning — 

Atropine, 462 
Jaundice — 

Aloes, 676 

Citric acid, 15 1 

Hydrastine, 487 

Iodoform, 333 

Iris, 681 

Iron, 197 

Manganese sulphate, 200 

Oxgall, 677 

Pilocarpine, 598 

Quinine, 217 

Salol, 321 
Joints, Inflammation of — 

Digitalis, 543 

Rubefacients, 771 



Keratitis — 

Gallicine, 715 

Yellow-oxide-of-mercury ointment, 233 
Kidneys, Congestion of — 
Digitalis, 543 
Juniper, 642 
Spirit of nitrous ether, 600 



Laryngeal Catarrh — 

Compound tincture of benzoin, 337 

Turpentine, 646 
Laryngeal Papillomata — 

Chromic acid, 759 
Laryngismus Stridulus — 

Bromides, 535 

Chloral, 419 
Laryngitis — 

Acacia, 780 

Aconite, 581 

Alum, 750 

Ammonium chloride, 619 

Camphor, 388 

Carbolic acid, 308 

Chromic acid, 758 

Glycerin, 776 

Iodine, 254 

Resorcin, 326 

Salol, 321 

Sanguinaria, 268 

Senega, 628 

Subsulphate of mercury, 235 

Succus conii, 503 

Tartar emetic, 610 
Larynx, Chronic Ulceration of — 

Silver nitrate, 745 
Larynx, Congestion of — 

Creasote, 311 
Lead-poisoning — 

Alum, 750 

Croton oil, 686 

Magnesium sulphate, 690 

Sulphuric acid, 146 
Lentigo — 

Tincture of iodine, 254 
Lepra — 

Arsenic, 243 

Phosphorus, 205 
Leucorrhea — 

Alum, 750 

Bismuth subnitrate, 753 

Bismuth tannate, 754 

Boric acid, 347 

Catechu, 718 

Chromic acid, 759 

Cocculus, 478 

Ergot, 483 

Fluid extract of hydrastis, 487 

Geranium, 723 

Glycerite of tannic acid, 776 

Grindelia, 509 

Hamamelis, 722 

Hematoxylon, 721 

Iron, 198 

Kino, 719 

Krameria, 720 

Lead acetate, 732 

Lime water, 164 

Myrrh, 339 

Potassium permanganate, 349 

Rhus glabra, 724 

Silver nitrate, 745 



828 



CLINICAL INDEX. 



Leucorrhea — 

Solution of zinc chloride, 762 

Tannic acid, 713 

Tar water, 626 

White oak, 717 

Zinc acetate, 737 

Zinc oxide, 737 

Zinc sulphate, 737 
Leukemia — 

Arsenic, 243 
Lichen — - 

Fowler's solution, 243 

Lead acetate, 732 

Sulphuric acid, 146 
Lithemia — 

Alkalies, 165 

Buchu, 640 

Lactic acid, 148 

Nitric acid, 145 
Lithiasis — 

Potassium permanganate, 349 
Liver, Torpor of — 

Podophyllum, 695 
Locomotor Ataxia — 

Acetanilid, 393 

Brain-extract, 221 

Caffeine, 560 

Mercury, 234 

Nitroglycerin, 529 

Phosphorus, 204 

Physostigma, 515 

Silver nitrate, 746 
Lumbago — 

Acetanilid, 393 

Burgundy-pitch plaster, 772 

Capsicum, 367 

Guaiac, 262 

Salicylic acid, 318 

Turpentine, 645 
Lungs, Chronic Affections of — 

Mercuiy, 234 
Lungs, Congestion of — 

Digitalis, 546 

Elaterin, 687 
Lungs, Inflammation of — 

Gelsemium, 507 
Lupus — 

Carbolic acid, 308 

Chloride of zinc, 762 

Copaiba, 649 

Hamamelis, 722 

Ichthyol, 328 

Phosphorus, 205 

Pyrogallol, 715 

Salicylic acid, 317 

Tincture of iodine, 254 

Zinc sulphate, 738 
Lymphadenoma — 

Phosphorus, 205 
Lymphangitis — 

Tannic acid, 713 
Lymphatic Enlargements — 

Ichthyol, 328 

Lead iodide, 734 



Lymphoma — 

Arsenic, 243 

Malaria — 

Antipyrine, 394 

Apioline, 709 

Arsenic, 243 

Carbolic acid, 309 

Citric acid, 151 

Eucalyptus, 344 

Hydrastine, 487 

Nuclein, 221 

Pilocarpine, 597 

Quinine, 217 
Malariail Fever — 

Ammonium iodide, 255 

Amyl nitrite, 528 

Quinine, 217 

Simple bitters, 180 
Malignant Pustule — 

Iodoform, 332 

Solution of chloride of antimony, 758 
Mammary Glands, Enlarged and 
Painful- 
Olive oil, 778 

Solution of ammonium acetate, 599 
Mania — 

Acetanilid, 393 

Arnica, 591 

Bromoform, 536 

Camphor, 389 

Cannabis, 452 

Conium, 503 

Digitalis, 546 

Ergot, 483 

Gelsemium, 506 

Hydrocyanic acid, 524 

Hyoscine, 466 
Marasmus — 

Bichloride of mercury, 235 

Cod liver oil, 137 
Mastitis — 

Ammonium chloride, 619 

Phytolacca, 587 
Measles — 

Mustard bath, 770 
Melancholia — 

Arsenic, 245 

Camphor, 389 

Cannabis, 452 

Diluted nitrohydrochloric acid, 145 

Hydrocyanic acid, 524 

"Wine of coca, 499 
Meniere's Disease — 

Gelsemium, 507 
Meningitis — 

Calomel, 234 

Digitalis, 546 

Iodides, 254 
Menopause, Disturbances of — 

Bromides, 535 
Menorrhagia — 

Aloes, 676 

Alum, 750 



CLINICAL INDEX. 



829 



Menorrhagia — 

Belladonna, 462 

Black haw, 520 

Bromides, 535 

Cannabis, 452 

Conium, 503 

Digitalis, 546 

Ergot, 482 

Gallic acid, 714 

Hamamelis, 722 

Iron, 198 

Kino, 719 

Savine, 706 

Solution of ammonium acetate, 599 

Tincture of cantharides, 767 

Turpentine, 646 
Menses, to Restore or Increase — 

Emij-ienagogues and ecbolics, 704 

Hedeoma, 710 

Mustard sitz-bath, 770 
Mercurial Sore Mouth — 

Silver nitrate, 745 
Metritis, Chronic — 

Cannabis, 452 

Ergot, 482 

Tincture of iodine, 254 
Metrorrhagia — 

Geranium, 723 
Migraine — 

Butyl-chloral hydrate, 424 

Caffeine, 560 

Cannabis, 452 

Gelsemium, 507 

Picrotoxin, 478 

Seidlitz powder, 690 

Solution of ammonium acetate, 599 
Mitral Regurgitation — 

Adonidin, 555 

Digitalis, 544 
Mitral Stenosis — 

Strophanthus, 540 
Moles — 

Nitric acid, 244 
Morbid Growths — 

Zinc chloride, 762 
Morphine-poisoning — 

Potassium permanganate, 349 

Strychnine, 475 
Mouth, Diseases of — 

Potassium citrate, 163 

Potassium tartrate, 163 
Mouth, Ulcerations of — 

Chromic acid, 759 
Mucous Membranes, Inflamed Con- 
ditions of — 

Demulcents, 774 
Mucous Patches — 

Potassium chlorate, 353 
Mumps — 

Pilocarpine, 597 
Muscarine-poisoning — 

Digitalis, 547 

Potassium permanganate, 350 



Myalgia — 

Ammonium chloride, 620 

Salcl, 321 

Turpentine, 645 
Myelitis — 

Ergot, 483 

PhenocoU, 396 

Strychnine, 474 
Myocarditis — 

Cactus, 554 

Caffeine, 560 

Diuretin, 655 
Myxedema — 

Thyroid extract, 220 

Narcotic Poisoning — 

Alcohol, 572 

Mustard, 770 

Rubefacients, 771 
Nasal Catarrh- 
Bismuth oxide, 754 

Bismuth subnitrate, 753 

Glycerin, 776 

Oil of Scotch fir, 624 
Nasal Polypi — 

Chromic acid, 758 

Nitrate of sanguinarine, 267 

Zinc sulphate, 738 
Nausea — 

Compound spirit of ether, 402 

Hydrochloric acid, 145 

Menthol, 377 
■ Spirit of nitrous ether, 600 
Neoplasms — 

Cocaine, 49S 
Nephritis — 

Amyl nitrate, 528 

Elaterin, 687 

Mercury, 234 

Potassium bitartrate, 165 

Potassium iodide, 255 

Scoparius, 553 

Terpin hydrate, 630 

Tincture of cantharides, 767 
Nervous Debility — 

Rubefacients, 771 
Nervous Diseases — 

Cod liver oil, 138 

Iron, 197 
Nervous Excitement — 

Rubefacients, 771 
Nervous Irritability — 

Bromides, 535 
Nervousness — 

Lactucarium, 448 
Neuralgia — 

Acetanilid, 393 

Aconite, 581 

Ammonium chloride, 620 

Arsenic, 244 

Belladonna plaster, 461 

Blisters, 763 

Butyl-chloral hydrate, 424 



830 



CLINICAL INDEX. 



Neuralgia — 

Camphor- chloral, 388 

Camphorated chloral, 419 

Cannabis, 452 

Cantharidal blister, 766 

Capsicum, 367 

Chloral, 420 

Colchicum, 259 

Convallaria, 556 

Croton oil, 685 

Ether, 402 

Gelsemium, 507 

Hydiocyanic acid, 524 

Hyoscyamus, 466 

Iron, 197 

Oil of cloves, 370 

Phenocoll, 396 

Phosphorus, 205 

Quinine, 217 

Rubefacients, 771 

Salicylic acid, 319 

Strychnine, 474 

Terpin hydrate, 630 

Turpentine, 645 

Veratrine ointment, 586 
Neurasthenia — 

Alcohol, 573 

Brain-extract, 219 

Phosphoric acid, 145 

Phosphorus, 204 

Sumbul, 519 
Neuritis — 

Acetanilid, 393 

Salol, 321 

Tincture of iodine, 253 . 
Nevi — 

Chloride of zinc, 762 

Niiric acid, 144 
Night-blindness — 

Strychnine, 474 
Night-sweats — 

Camphoric acid, 389 

Fluid extract of hydrastis, 488 

Gallic acid, 715 

Geranium, 723 

Lead acetate, 733 

Physostigma, 515 

Picrotoxin, 477 

Strychnine, 475 

Zinc oxide, 737 
Nocturnal Emissions — 

Digitalis, 546 
Noma — 

Hydrochloric acid, 143 
Nose, Diseases of — 

Aristol, 333 

Ichthyol, 328 

Iodoform, 333 

Nitric acid, 144 
Nymphom ania — 

Bromides, 535 
Nystagmus — 

Physostigmine sulphate, 514 



Obesity — 

Phytolacca, 588 

Thyroid extract, 221 
Offensive Discharges — 

Lead nitrate, 734 
Onychia — 
• Lead nitrate, 734 

Tincture of iodine, 253 
Ophthalmia — 

Alum, 750 

Bismuth tannate, 754 

Potassium permanganate, 349 

Silver nitrate, 745 

Zinc sulphate, 737, 738 
Opium Habit — 

Cocaine, 499 
Opium -poisoning — 

Caffeine, 560 

Picrotoxin, 477 
Orchitis — 

Ammonium chloride, 619 

Belladonna ointment, 461 

Hop poultice, 447 

Lead acetate, 732 

Mercurial ointment, 233 

Silver nitrate, 735 
Os Uteri, Rigidity of— 

Ipecac, 614 
Osteitis — 

Hydrochloric acid, 144 
Osteomalacia — 

Lime water, 166 

Phosphorus, 205 
Otitis— 

Antipyrine, 394 

Bismuth subgallate, 754 

Cantharidal blister, 767 

Carbolic acid, 308 

Cod-liver oil, 138 

Zinc sulphate, 737 
Otorrhea — 

Carbolic acid, 308 

Lead acetate, 732 

Salicylic acid, 318 

Silver nitrate, 746 

Tannic acid, 713 
Ovarian Neuralgia — 

Sumbul, 519 
Ovaritis — 

Cantharidal blister, 767 
Oxalic-acid-poisoning — 

Potassium permanganate, 350 
Oxaluria — 

Lactic acid, 148 

Nitric acid, 145 

Zinc sulphate, ']'}^% 
Ozena — 

Bismuth oxide, 754 

Bismuth subnitrate, 753 

Camphor, 388 

Camphorated naphtol, 324 

Chromic acid, 759 

Cod-liver oil, 138 



CLINICAL INDEX. 



831 



Ozena — 

Krameria, 720 

Myrrh, 339 

Potassium permanganate, 349 

Quinine, 217 

Saccharin, 658 

Salol, 321 

Solution of chlorinated soda, 359 

Tannic acid, 713 

Pachymeningitis — 

Red-iodide-of-mercury ointment, 234 
Pain- 
Ether, 402 

Opium, 440 
Palpitation of Heart — 

Aconite, 581 

Compound spirit of ether, 402 
Palsy— 

Brain-extract, 222 
Pannus — 

Yellow-oxide-of-mercury ointment, 233 
Paralysis — 

Brain-extract, 222 

Cocculus, 477 

Cubeb, 653 

Iodides, 254 

Mezereum, 269 

Phosphorus, 205 

Rhus toxicodendron, 490 

Strychnine, 474 
Paralysis Agitans — 

Borax, 348 

Cocaine, 499 

Conium, 503 

Gelsemium, 506 

Hyoscine, 466 

Sparteine sulphate, 553 
Paralytic Mydriasis — 

Physostigmine, 514 
Paraplegia — 

Phosphorus, 204 

Physostigma, 515 

Strychnine, 474 
Parasitic Skin Diseases — 

Chlorine water, 358 

Cocculus, 477 

Salicylic acid, 317 

Sulphurous acid, 355 
Paronychia — 

Lead acetate, 732 
Pelvic Cellulitis — 

Mercurial ointment, 233 
Pemphigus — 

Fowler's solution, 243 

Rhus toxicodendron, 490 
Pericarditis — 

Blisters, 763 

Calomel, 235 

Cantharidal blister, 766 

Diuretin, 655 

Iodides, 255 

Squill, 638 



Periodical Fevers — 

Nitric acid, 145 
Periostitis — 

Cantharidal blister, 767 

Iodides, 254 

Tincture of iodine, 253 
Peritonitis — 

Aconite, 581 

Opium, 441 

Turpentine, 645 
Pernicious Anemia — 

Arsenic, 243 

Phosphorus, 205 
Phagedenic Sores — 

Potassium chlorate, 353 

Solution of nitrate of mercury, 234 
Pharyngitis — 

Acacia, 780 

Aconite, 581 

Alcohol, 571 

Ammonium chloride, 619 

Aromatic spirit of ammonia, 577 

Balsam of tolu, 621 

Borax, 347 

Boric acid, 347 

Calendula, 180 

Camphoric acid, 389 

Capsicum, 367 

Catechu, 718 

Ergot, 482 

Gallic acid, 714 

Glycerin, 776 

Guaiac, 262 

Hamamelis, 722 

Hedeoma, 710 

Kino, 718 

Krameria, 720 

Myrrh, 339 

Phytolacca, 587 

Potassium bichromate, 35 1 

Potassium bromide, 534 

Potassium chlorate, 353 

Potassium nitrate, 592 

Resorcin, 326 

Rhus glabra, 724 

Sodium benzoate, 338 

Sodium bicarbonate, 163 

Solution of ammonium acetate, 599 

Sulphur, 673 

Sulphurous acid, 355 

Tannic acid, 713 

Tincture of hydrastis, 487 

Tincture of iodine, 254 

Xanthoxylum, 271 
Pharynx, Catarrhal Affections of — 

Compound tincture of benzoin, 337 
Phimosis — 

Cocaine, 498 
Phlegmasia Dolens — 

Hamamelis, 722 
Phlyctenular Ophthalmia — 

Yellow-oxide-of-mercury ointment, 233 



832 



CLINICAL INDEX. 



Phosphorus-poisoning — 

Magnesium carbonate, 670 
Ozonized oil of turpentine, 646 
Potassium permanganate, 350 
Photophobia — 

Physostigmine, 514 
Phthiriasis — 

Pilocarpine, 598 
Phthisis— 

Acetanilid, 392 
Alcohol, 573 
Arsenic, 244 
Benzoic acid, 337 
Catechu, 718 
Codeine, 445 
Creasote, 311 
Croton oil, 682 
Gallic acid, 715 
Geranium, 723 
Guaiacol, 314 
Iodine, 254 
Iodoform, 333 
Quinine, 217 
Salicylic acid, 318 
Sulphurous acid, 355 
Tar, 626 
Terebene, 629 

Thymol, 379 

Wild cherry, 180 
Physostigmine-poisoning — 

Atropine, 462 

Strychnine, 475 
Pityriasis — 

Acetic acid, 150 

Aromatic spirit of ammonia, 164 

Resorcin, 326 
Pleura, Chronic Affections of — 

Mercury, 234 
Pleurisy — 

Aconite, 581 

Blisters, 763 

Burgundy pitch plaster, 772 

Cantharidal blister, 766 

Coniine, 503 

Gelsemium, 507 

Iodides, 255 

Opium, 441 

Quinine, 217 

Salicylic acid, 319 

Squill, 638 

Tincture of iodine, 253 

Turpentine, 645 
Pleuritic Effusion — 

Caffeine, 560 

Digitalis, 547 

Diuretin, 654 

Pilocarpine, 597 

Salines, 690 
Pneumonia — 

Acetanilid, 392 

Aconite, 581 

Alcohol, 572 

Ammonium carbonate, 577 

Ammonium iodide, 255 



Pneumonia — 

Apomorphine, 606 
Arsenic, 245 
Aspidosperma, 518 
Calomel, 235 
Cantharidal blister, 766 
Coniine, 503 
Digitalis, 546 
Grindelia, 509 
Hydrogen dioxide, 354 
Iodides, 255 
Ipecac, 614 
Potassium nitrate, 593 
Quinine, 217 
Senega, 628 
Serpentaria, 180 
Serum-therapy, 295 
Strychnine, 473 
Turpentine, 646 
Pneumothorax — 

Carbolic acid, 308 
Poisoning — 

Apomorphine, 606 
Poisoning from Noxious Gases — 

Ammonia, 577 
Poisoning from Venomous Reptiles- 
Alcohol, 572 
Ammonia, 577 
Polypi — 

Hamamelis, 722 
Zinc chloride, 762 
Polyuria — 
Alum, 750 
Kino, 719 
Portal Congestion — 

Colchicum, 259 
Post-partum Hemorrhage — 
Digitalis, 546 
Ergot, 482 
Ether, 402 

Sodio-benzoate of caffeine, 560 
Strychnine, 475 
Priapism — 

Lupulin, 447 
Prickly Heat- 
Citric acid, 150 
Proctitis — 

Copaiba, 650 
Progressive Paralysis of the Insane- 

Physostigma, 515 
Prolapsus Ani — 

Bismuth subnitrate, 753 
Ergot, 482 
Geranium, 723 
Krameria, 720 
Nitric acid, 144 
Strychnine, 473 
Tannic acid, 713 
White oak, 717 
Prolapsus of Iris — 
Physostigmine, 514 
Prolapsus Uteri — 
Iron, 197 



CLINICAL INDEX. 



833 



Prostate Gland, Enlargement of- 

Ergot, 482 
Prostatitis — 

Belladonna, 462 

Hyoscyamus, 466 
Prostatorrhea — 

Iron, 198 

Tincture of cantharides, 767 

Turpentine, 646 
Prurigo — 

Ergot, 483 
' Fowler's solution, 243 

Sulphuric acid, 146 
Pruritus — 

Aconite, 581 

Alum, 750 

Camphorated chloral, 419 

Cannabis, 452 

Carbolic acid, 308 

Ether, 402 

Gallanol, 715 

Gelsemium, 507 

Hydrocyanic acid, 524 

Menthol, 377 

Nitric acid, 144 

Pilocarpine, 598 

Piperazin, 657 

Salicylic acid, 318 

Solution of lead subacetate, 733 

Tar, 626 

Zinc sulphate, 737 
Pruritus Ani — 

Silver nitrate, 745 
Pruritus Vulvae — • 

Silver nitrate, 745 
Psoriasis — 

Ammonium carbonate, 577 

Arsenic, 243 

Copaiba, 649 

Eucalyptus, 343 

Gallanol, 715 

Lead iodide, 734 

Phosphorus, 205 

Pilocarpine, 598 

Pyrogallol, 715 

Resorcin, 326 

Salicylic acid, 317 

Strophanthus, 551 

Sulphur, 672 

Thyroid extract, 221 

Turpentine, 645 
Ptyalism — 

Alum, 749 

Bismuth subnitrate, 753 

Catechu, 718 

Copper sulphate, 740 

Krameria, 720 

Myrrh, 339 

Pilocarpine, 597 

Potassium chlorate, 353 

Rhus glabra, 724 
Puerperal Eclampsia — 

Arayl nitrite, 528 

Conium, 503 

53 



Puerperal Fever — 

Opium, 441 

Quinine, 217 

Terebene, 629 

Turpentine, 646 
Pulmonary Affections, Chronic- 

Cetraria, 780 

Nuclein, 221 

Turpentine, 646 
Purpura — 

Digitalis, 546 

Ergot, 483 

Hamamelis, 722 

Sulphuric acid, 146 

Turpentine, 646 
Putrid Sore Throat- 
Potassium permanganate, 349 
Pyelitis — 

Benzoic acid, 337 

Buchu, 640 

Copaiba, 650 

Gallic acid, 715 

Hamamelis, 722 

Tincture of cantharides, 767 
Pyelo-nephritis — 

Gallic acid, 715 
Pyemia — 

Alcohol, 573 

Iron, 198 

Quinine, 217 
Pyonephrosis — 

Turpentine, 646 
Pyorrhea Alveolaris — 

Hydronaphtol, 324 

Tincture of iodine, 254 
Pyros's — 

Bismuth subnitrate, 754 

Catechu, 718 

Glycerin, 777 

Kino, 719 

Manganese dioxide, 200 

Rabies — 

Serum-therapy, 302 
Rachitis — 

Cod liver oil, 137 

Lime water, 166 

Phosphorus, 205 
Rectal Bleeding — 

Krameria, 720 
Rectal Fissure — 

Hamamelis, 722 
Rectal Prolapse — 

Nutgall ointment, 716 
Rectal Ulcer — 

Fluid extract of hydrastis, 487 

Hamamelis, 722 

Potassium chlorate, 353 

Silver nitrate, 746 

Tannic acid, 713 
Relaxed Uvula — 

Capsicum, 367 

White oak, 717 



834 



CLINICAL INDEX. 



Remittent Fever — 

Gelsemium, 507 

Ipecac, 614 

Iris, 68 r 
Renal Calculi — 

Piperazin, 657 
Renal Colic — 

Piperazin, 657 
Renal Hemorrhage — 

Physostigma, 515 
Respiratory Organs, Inflamed Condi- 
tions of — 

Althaa, 781 
Restlessness of Fever — 

Convallaria, 556 
Retention of Urine — 

Strychnine, 474 
Rheumatic Affections — 

Rhus toxicodendron, 490 
Rheumatic Arthritis — 

Piperazin, 657 

Sahcyhc acid, 318 
Rheumatic Pains — 

Capsicum, 367 

Turpentine, 645 
Rheumatism — 

Acetanilid, 392 

Aconite, 581 

Alkahes, 165 

Ammonium liniment, 577 

Ammonium chloride, 620 

Arnica, 591 

Arsenic, 245 

Asaprol, 324 

Aspidospermine, 519 

Belladonna plaster, 461 

Betol, 324 

Bromides, 535 

Buchu, 640 

Burgundy-pitch plaster, 772 

Camphoric acid, 389 

Citric acid, 15 1 

Cod liver oil, 137 

Colchicum, 259 

Guaiac, 262 

Hamamelis, 722 

Mezereon, 269 

Phenocoll, 396 

Phytolacca, 587 

Potassium iodide, 255 

Potassium nitrate, 593 

Salicylic acid, 318 

Sanguinaria, 268 

Senega, 628 

Sodium bicarbonate, 163 

Sodium phosphate, 690 

Solution of ammonium acetate, 599 

Sulphur, 673 

Tansy, 708 

Tincture of camphor, 571 

Tincture of iodine, 253 
Rheumatoid Arthritis — 

Alkalies, 165 

Arsenic, 245 



Rheumatoid Arthritis- 
Cod liver oil, 137 

Colchicum, 259 
Rhinitis — 

Nitrate of sanguinarine, 267 
Rhus-poisoning — 

Grindelia, 509 

Hamamelis, 722 

Serpentaria, 181 
Ringworm — 

Acetic acid, 150 

Compound tincture of benzoin, 337 

Copper sulphate, 740 

Salicylic acid, 319 

Salivary Fistula — 

Arsenic, 242 

Chromic acid, 759 
Scabies — 

Copper sulphate, 740 

Hyposulphites, 357 

Sulphur ointment, 672 
Scales, Removal of— 

Olive oil, 778 
Scarlatina — 

Belladonna, 461 
Scarlatinal Angina — 

Sanguinaria, 267 
Scarlet Fever — 

Digitalis, 546 

Mustard bath, 770 
Sciatica — 

Acetanilid, 393 

Blisters, 763 

Cantharidal blisters, 766 

Colchicine, 259 

Ether, 402 

Nitroglycerin, 529 

Phenocoll, 396 

Potassium iodide, 255 

Salicylic acid, 318 

Sulphur, 673 
Sclerosis — 

Mercury, 234 

Potassium iodide, 254 
Sclerotitis — 

Salicylic acid, 318 
Scrofula — 

Cod liver oil, 137 

Hypophosphites, 208 

Iron iodide, 197 

Phytolacca, 587 

Potassium iodide, 254 

Sarsaparilla, 264 
Scrofulous Glands — 

Zinc chloride, 762 
Scrofulous Sores — 

Conium, 503 

Phosphoric acid, 144 
Scurvy — 

Citric acid, 15 1 

Sulphuric acid, 146 
Sea-sickness — 

Acetanilid, 393 



CLINICAL INDEX. 



835 



Sea-sickness — 

Belladonna, 462 

Chloral, 420 

Chloral formamide, 424 

Cocaine, 499 
Seat-worms — 

Quassia, 180 
Sebaceous Cysts — 

Ether, 402 
Seborrhea — 

Hamamelis, 722 

Hydrastine ointment, 487 

Resorcin, 326 
Seminal Emissions — 

Iron, 198 
Senile Debility— 

Brain-extract, 221 

Spermine, 219 
Senile Gangrene — 

Camphor, 389 
Septicemia — 

Alcohol, 573 

Iron, 198 

Quinine, 217 

Serum -therapy, 298 
Sequestra — 

Hydrochloric acid, 144 
Sexual Excitement — 

Monobromated camphor, 389 
Shock- 
Digitalis, 545 

Ether, 402 

Opium, 441 
Skin, Diseases of — 

Acetic acid, 150 

Aristol, 333 

Cod liver oil, 137 

Eucalyptus, 343 

Hydrochloric acid, 145 

Iodoform, 333 

Liquor potassae, 163 

Potassium carbonate, 163 

Sulphuric acid, 146 
Skin, Irritable and Inflamed Condi- 
tions of — 

Althaea, 781 
Sleeplessness — 

Lactucarium, 448 
Small-pox — 

Alcohol, 572 

Sulphur, 673 
Sore Nipples — 

Silver nitrate, 745 

Tannic acid, 713 
Sore Throat- 
Acetic acid, 150 

Alum, 749 

Hydrochloric acid, 143 

Liquorice, 623 
Sores, Foul-smelling — 

Hematoxylon, 721 
Spasmodic Rigidity of Os Uteri — 

Belladonna ointment, 461 



Spasmodic Rigidity of Os Uteri — 

Chloral, 420 
Spermatorrhea — 

Belladonna, 462 

Bromides, 535 

Camphoric acid, 389 

Digitalis, 546 

Ergot, 483 

Gelsemium, 507 

Lupulin, 447 

Strychnine, 475 

Tincture of cantharides, 767 

Turpentine, 646 
Spinal Congestion — 

Belladonna, 462 

Ergot, 483 
Spinal Diseases — 

Acetanihd, 393 
Spinal Meningitis — 

Blisters, 763 
Splenic Enlargements — 

Ergot, 483 

Lead iodide, 734 

Red-iodide-of-mercury ointment, 234 
Spongy Gums — 

Catechu, 718 

Krameria, 720 

Myrrh, 339 

Rhus glabra, 724 

Tannic acid, 713 

Tincture of benzoin, 337 
Sprains — 

Alcohol, 571 

Arnica, 591 

Calendula, 180 

Camphor liniment, 388 

Hamamelis, 722 

Olive oil, 778 

Rhus toxicodendron, 490 

Solution of lead subacetate, 733 

Tansy, 708 
Sthenic Fevers — 

Chloral, 421 
Stomatitis — 

Alum, 749 

Bismuth subnitrate, 753 

Chlorine water, 358 

Copper sulphate, 740 

Geranium, 723 

Salicylic acid, 318 

Tannic acid, 713 

Thymol, 379 

Zinc sulphate, 737 
Strabismus — 

Bromides, 534 
Strangury — 

Demulcents, 774 

Onion poultice, 622 
Stricture — 

Aconite, 581 

Olive oil, 778 
Strumous Affections — 

Sanguinaria, 268 



836 



CLINICAL INDEX. 



Strychnine-poisoning — 

Amyl nitrite, 528 

Bromides, 534 

Chloral, 420 

Coniine, 503 

Hydrastine hydrochlorate, 488 

Potassium permanganate, 350 
Subinvolution — 

Cannabis, 452 

Ergot, 484 

Glycerite of tannic acid, 776 
Sweating — 

Alcohol, 571 

Alum, 750 

Belladonna, 461 

Bismuth subnitrate, 753 

Camphoric acid, 389 

Ergot, 483 

Gallic acid, 715 

Hematoxyion, 721 

Kino, 719 

Lead oxide, 734 

Pilocarpine, 597 

Red rose, 725 

Silver oxide, 746 

Sulphuric acid, 146 

Zinc oxide, 737 
Swellings, Glandular — 

Tincture of iodine, 253 
Swellings, Inflammatory — 

Ammonium chloride, 619 

Hyposulphites, 357 
Sycosis — 

Phytolacca, 587 

Resorcin, 326 

Salicylic acid, 317 

Salol, 321 

Sulphur, 672 

Tannic acid, 713 
Sympathetic Cough — 

Asafetida, 389 
Syncope — 

Alcohol, 572 

Mustard, 770 
Synovitis — 

Belladonna ointment, 460 

Cantharidal blister, 767 

Ichthyol, 328 

Iodoform, 332 

Lead acetate, 732 

Mercurial ointment, 233 

Tincture of iodine, 253 

Vesicants, 763 
Syphilis — 

Arsenic, 245 

Bromides, 535 

Chloride of zinc, 762 

Chromic acid, 758 

Cod-liver oil, 138 

Guaiac, 262 

Iodides, 254 

Iodoform, 333 

Iron, iodide, 197 

Mercurial preparations, 233 



Syphilis — 
Mezereon, 269 
Nitric acid, 145 
Papain, 134 
Phytolacca, 587 
Sanguinaria, 268 
Sarsaparilla, 264 
Serum-therapy, 298 
Silver iodide, 746 
Thyroid extract, 221 

Tabes Dorsalis — 

Acetanilid, 393 
Tape- worms — 

Carbolic acid, 309 

Ether, 402 

Kousso, 701 

Male fern, 700 

Pomegranate, 702 

Pumpkin seed, 703 

Salicylic acid, 319 
Tetanus — 

Acetanilid, 393 

Amyl nitrite, 528 

Bromides, 535 

Chloral, 420 

Conium, 503 

Curare, 517 

Gelsemium, 506 

Opium, 440 

Physostigma, 515 

Salicylic acid, 318 

Serum-therapy, 283 

Strychnine, 474 

Thyroid extract, 221 
Tetany— 

Thyroid extract, 220 
Thirst, to Quench— 

Demulcents, 774 
Thread-worms — 

Rhubarb, 679 
Throat, Acute Inflammation of— 

Tartar emetic, 609 
Throat, Diseases of — 

Aristol, 333 

Iodoform, 333 

Liquor potassse, 163 

Nitric acid, 144 

Pilocarpine, 597 
Throat, Relaxed — 

Myrrh, 339 
Thrombosis — 

Ammonia, 578 
Thrush — 

Sodium bicarbonate, 164 

Sodium sulphocarbolate, 310 
Thyroid Gland, Enlargement of— 

Iris, 681 
Tic Douloureux — 

Aconite, 581 

Butyl-chloral hydrate, 424 

Strychnine, 474 

Veratrine ointment, 586 



CLINICAL INDEX. 



837 



Tinea Capitis — 

Carbolic acid, 308 
Tinea Circinata — 

Cantharidal blister, 767 

Carbolic acid, 308 
Tinea Sycosis — 

Copper sulphate, 740 
Tinea Tarsi- 
Copper sulphate, 740 
Tinea Tonsurans — 

Cantharidal blister, 767 

Carbolic acid, 308 

Hydronaphthol, 324 

Tincture of iodine, 254 

Turpentine, 645 
Tinea Versicolor — 

Sulphur ointment, 672 
Toadstool-poisoning — 

Atropine, 462 
Tobacco Habit- 
Cocaine, 499 

Strophanthus, 551 
Tongue, Fissure of — 

Glycerin, 776 
Tongue, Tuberculosis of — 

Chromic acid, 759 
Tonsillitis — 

Aconite, 581 

Alum, 749 

Camphorated naphtol, 324 

Gallic acid, 714 

Guaiac, 262 

Guaiacol, 314 

Phytolacca, 587 

Quinine, 217 

Rhus glabra, 724 

Salicylic acid, 318 

Silver nitrate, 745 

Sodium bicarbonate, 163 

Sodium sulphocarbolate, 310 

Tannic acid, 713 
Tonsils, Enlarged — 

Zinc iodide, 738 

Zinc sulphate, 738 
Toothache— 

Campho-phenique, 308 

Camphorated chloral, 419 

Capsicum, 367 

Creosote, 309 

Oil of cloves, 370 
Torticollis — 

Capsicum, 367 
Trachea, Congestion of — 

Creosote, 311 
Tracheitis — 

Ipecac, 613 

Silver nitrate, 745 

Terpin hydrate, 630 
Trachoma — 

Alum, 750 

Bismuth subnitrate, 753 
Trichophytosis — 

Gallonal, 715 



Tubercular Joints — 

Iodoform, 332 
Tuberculosis — 

Benzoyl -eugenol, 371 

Bone-marrow, 221 

Camphorated naphtol, 324 

Cantharidin, 767 

Cod liver oil, 137 

Creosote, 311 

Guaiacol, 314 

Hydronaphtol, 324 

Hypophosphites, 208 

Iron, 197 

Nuclein, 221 

Phosphoric acid, 144 

Serum-therapy, 293 

Sulphur, 673 
Tuberculous Ulceration — 

Calcium phosphate, 208 

Lactic acid, 148 
Turgescence of Nasal Mucous Mem. 
brane — 

Cubeb, 652 
Tylosis — 

Salicylic acid, 317 
Tympanites — 

Asafetida, 389 

Turpentine, 646 
Typhoid Fever — 

Acacia, 780 

Alcohol, 572 

Bismuth salicylate, 754 

Borax, 348 

Camphor, 389 

Carbolic acid, 309 

Digitalis, 546 

Eucalyptus, 344 

Hydrochloric acid, 145 

Hydronaphtol, 324 

Hyposulphites 357 

Nuclein, 221 

Oxgall, 677 

Potassium chlorate, 353 

Quinine, 218 

Salicylic acid, 318 

Serpentaria, 181 

Serum-therapy, 299 

Sodium sulphocarbolate, 310 

Strychnine, 473 

Sulphur, 673 

Thymol, 379 

Turpentine, 646 

Zinc sulphate, 738 
Typhus Fever — 

Alcohol, 572 

Camphor, 389 

Serpentaria, 1 81 

Ulcerated Nipples — 

Catechu, 717 
Ulceration, Phagedenic — 

Nitric acid, 144 
Ulcerations, Superficial — 

Castor oil, 668 



838 



CLINICAL INDEX. 



Ulcer of Cervix — 

Carbolic acid, 308 
Ulcer of Stomach — 

Pepsin, 132 

Resorcin, 327 
Ulcerous Gums — 

Tannic acid, 713 
Ulcers — 

Alcohol, 571 

Alum, 750 

Alumnol, 324 

Aristol, T,T,T, 

Bismuth benzoate, 337 

Bismuih subgallate, 754 

Bismuth subiodide, 754 

Bismuth subnitrate, 753 

Camphor ointment, 388 

Cantharidal blister, 766 

Carbolic acid, 308 

Catechu, 717 

Chloral, 418 

Chloride of zinc, 762 

Chromic acid, 759 

Copaiba, 649 

Copper sulphate, 740 

Fluid extract of hydrastis, 487 

Galla, 716 

Grindelia, 509 

Hydrogen dioxide, 354 

Iodoform, 332 

Iron sulphate, 196 

Kino, 718 

Lycopodium, 783 

Nitrate of sanguinarine, 267 

Nuclein, 221 

Phytolacca, 587 

Potassium bromide, 534 

Potassium chlorate, 353 

Potassium permanganate, 349 

Resorcin, 326 

Rhus glabra, 724 

Silver nitrate, 745 

Solution of chlorinated soda, 359 

Tannic acid, 713 

Tar, 626 

Terebene, 629 

Vesicants, 763 

White oak, 717 

Zinc oxide, 737 

Zinc sulphate, 738 
Ulcers of Mouth and Throat — 

Tincture of hydrastis, 487 
Ulcers, Syphilitic — 

Carbolic acid, 308 

Resorcin, 326 
Ulcers, Venereal — 

Calomel, 233 
Uremia — 

Opium, 440 

Pilocarpine, 597 
Uremic Convulsions — 

Chloral, 420 
Urethral Caruncles — 

Cocaine, 497 



Urethritis — 

Buchu, 640 

Elm, 781 
Uric-acid Diathesis — 

Lithium bromide, 535 

Lithium preparations, 166 
Urinary Organs, Inflamed Conditions 
of— 

Althcea, 781 
Urticaria — 

Alcohol, 571 

Anderson's powder, 388 

Citric acid, 150 

Copaiba, 650 

Ergot, 483 

Ether, 402 

Hamamelis, 722 

Hydrocyanic acid, 524 

Menthol, 377 

Solution of lead subacetate, 733 
Uterine Cancer — 

Conium, 503 

Iodoform, 332 

Terebene, 629 
Uterine Contraction, to Stimulate — 

Quinine, 218 
Uterine Fibroids — 

Ergot, 482 
Uterine Hemorrhage — 

Alcohol, 571 

Catechu, 718 

Cinnamon, 364 

Ergot, 482 

Hamamelis, 722 

Hydrastine, 487 

Ipecac, 613 

Krameria, 720 

Red rose, 725 

Senegin, 628 

White oak, 717 
Uterine Polypi — 

Ergot, 482 
Uterine Tumors — 

Ergot, 484 
Uterine Ulcerations — 

Fluid extract of hydrastis, 487 

Iodoform, 332 
Uterus, Congestion of — 

Croton oil, 685 

Glycerite of tannic acid, 776 
Uterus, to Dilate Neck of^ 

Elm, 781 
Uvula, Relaxation of 

Alum, 749 

Catechu, 718 

Kino, 718 

Krameria, 720 

Vaginal Ulcerations — 

Fluid extract of hydrastis, 487 
Vaginitis — 

Ammonium chloride, 619 
Copaiba, 650 



CLINICAL INDEX. 



839 



Vaginitis — 

Grindelia, 509 

Lime water, 164 
Valvular Diseases of Heart — 

Convallaria, 556 

Digitalis, 543 

vSparteine sulphate, 553 

Strophanthus, 550 
Varicocele — 

Ergot, 482 

Hamamelis, 722 
Varicose Ulcers — 

Hamamelis, 722 
Varicose Veins — 

Ergot, 482 

Hamamelis, 722 
Variola — 

Glycerite of starch, 776 
Venereal Sores — 

Black wash, 164 

Hydrogen dioxide, 354 

vSalol, 321 

Solution of nitrate of mercury, 234 

Yellow wash, 164 
Venereal Warts — 

Nitric acid, 144 
Verruca — 

Alum, 749 

Salicylic acid, 317 
Vertigo— 

Cubeb, 653 

Valerian, 390 
Vesical Calculi — 

Piperazin, 657 
Vesical Catarrh — 

Silver nitrate, 746 

Tar water, 626 

Thymol, 379 
Vesical Tenesmus — 

Hyoscyamus, 466 
Vomiting — 

Ammonium bromide, 535 

Bismuth subnitrate, 753 

Caffeine, 561 

Calomel, 234 

Cantharidal blister, 767 

Champagne, 572 

Cocaine, 499 

Gray powder, 234 

Hydrochloric acid, 145 

Hydrocyanic acid, 524 

Ipecac, 613 

Lime water, 164 

Menthol, 377 

Quinine, 218 
Vomiting of Pregnancy — 

Ammonium bromide, 535 

Cerium oxalate, 755 

Chloral, 420 

Strychnine, 473 
Vomiting of Uterine Disease — 

Cerium oxalate, 755 
Vulvitis — 

Zinc sulphate, 737 



Warts — 

Acetic acid, 150 

Arsenic, 242 

Glacial acetic acid, 760 

Potassium bichromate, 35 1 

Salicylic acid, 317 
Wasting Diseases — 

Cod liver oil, 137 

Phosphoric acid, 145 
Whooping Cough — 

Acetanilid, 393 

Alum, 750 

Ammonium chloride, 619 

Asafetida, 389 

Belladonna, 461 

Bromides, 535 

Bromoform, 535 

Caffeine, 561 

Chloral, 419 

Cod liver oil, 137 

Coffee, 560 

Conium, 503 

Ergot, 483 

Gelsemium, 506 

Grindeha, 509 

Hydrocyanic acid, 524 

Hyoscyamus, 466 

Ouabain, 551 

Quinine, 218 

Resorcin, 326 

Silver nitrate, 745 

Syrup of garlic, 622 

Tannic acid, 713 

Terebene, 629 

Zinc oxide, 737 

Zinc sulphate, 738 
Worms — 

Anthelmintics, 695 

Chenopodium, 697 

Kamala, 703 

Olive oil, 778 

Santonin, 698 

Spigelia, 699 
Wounds — 

Alcohol, 571 

Bismuth subgallate, 754 

Bismuth subnitrate, 753 

Campho-phenique, 388 

Chlorine water, 358 

Compound tincture of benzoin, 336 

Glycerin, 776 

Iodoform, 332 

Olive oil, 778 

Resorcin, 326 

Rhus glabra, 724 

Salol, 321 

Silver nitrate, 745 

Sulphurous acid, 355 

Terebene, 629 

Turpentine, 645 

Yellow Fever — 

Hyposulphites, 357 
Turpentine, 646 



GENERAL INDEX. 



Note. — The bold-face figures indicate the pages on which the drugs are treated 
in extenso. 



Absolute alcohol, 562 
Abstracta, 98 
Abstracts, 98 
Acacia, 773, 779 
Aceta, 84 
Acetanilid, 390 
Acetanilidum, 390 
Acetic acid, 148 
glacial, 763 

ether, 410 
Acetum opii, 43c 

sanguinarige, 266 

scilla, 637 
Acid phosphates, 55 
Acidum aceticum, 148 
dilutum, 149 
glaciale, 760 

arsenosum, 236 

benzoicum, 334 

boricum, 346 

camphoricum, 383 

carbolicum, 304 
iodatum, 305 

chromicum, 758 

citricum, 149 

gallicum, 714 

hydrobromicum dilutum, 53 1 

hydrochloricum, 140 
dilutum, 138 

hydrocyanicum dilutum, 521, 742 

hypophosphorosum dilutum, 207 

lacticum, 146 

nitricum^, 141 
dilutum, 141 

nitrohydrochloricum, 140, 141 
dilutum, 140, 141 

phosphoricum, 140 

salicylicum, 315 

sulphuricum, 140 
aromaticum, 141 
dilutum, 141 

sulphurosum, 355 

tannicum, 712 

tartaricum, 149 
Aconite, 578 
Aconitine, 579 
Aconitum, 578 
Adeps benzoinatus, 334 
Adhesive plaster, 125 
Adonis vernalis, 554 
^ther, 399 



Albuminate of iron, 192 
Alcohol, 561, 604, 771 

absolutum, 562 

deodoratum, 562 
Alcoholic extract of belladonna leaves, 454 

eye-wash, 60 
Ale, 564 

Alkali solutions, 55 
Alkalies, 151, 617 
Alkaline salt solutions, 54 
Allium, 621 

cepa, 621 
Allspice, 371 
Almond, 773 

oil, 773 
Almonds, comp., 104 
Aloe, 674 

barbadensis, 674 

purificata, 675 

socotrina, 675 
Aloes, 674, 704 
Aloin, 676 
Aloinum, 676 
Althaea, 781 
Alum, 711, 747 

(burnt), 757 
Alumen, 747 

exsiccatum, 747 
Alumini hydras, 748 

sulphas, 748 
Aluminis glyceritum, 747 
Aluminum aceto-tartrate, 747 

boroformate, 748 

hydrate, 748 

sulphate, 748 
Alumnol, 322, 324, 747 
American hellebore, 582 

wormseed, 696 
Ammonia, 771 

(confined vapor), 763 

liniment, 575 

water, 575 
Ammoniac, 382 

plaster with mercury, 225, 382 
Ammoniacum, 382 
Ammoniated glycyrrhizin, 623 

mercury, 224 

tincture of guaiac, 261 
of valerian, 384 
Ammonii benzoas, 334 

bromidum, 529 

841 



842 



GENERAL INDEX. 



Ammonii carbonas, 158, 575 

chloridum, 618 

valerianas, 384 
Ammonio-ferric alum, 188 

sulphate, 188 

tartrate, 188 
Ammonium, 604 

benzoate, 334 

bromide, 529 

carbonate, 158, 575 

chlorate, 616, 618 

iodide, 247 

iodidum, 247 

valerianate, 384 
Amyl nitris, 525 

nitrate, 525, 604 
Amylene hydrate, 412 
Anemonin, 588 
Anesthetics, 398 

Anhydro-ortho-sulphanin-benzoic acid, 657 
Animal charcoal, 774 

extracts, 219 
Anise, 361 

water, 362 
Anisum, 361 
Anthelmintics, 695 
Anthemis, 174 

Antimonii et potassii tartras, 606 
Antimony chloride, 757 

and potassium tartrate, 602, 606, 617 
Antipyrine, 394 
Antiseplol, 329 
Antispasmodics, 381 
Apiol, 704, 709 
Apiolum, 709 
Apomorphine, 617 

hydrochlorate, 602 
Aqua acidi carbolici, 304 

ammonia fortior, 574 

ammoniae, 575 

anisi, 362 

camphorae, 383 

chlori, 357 

chloroformi, 405 

cinnamomi, 364 

creosoti, 311 

eucalypti, 341 

foeniculi, 366 

hydrogenii dioxidi, 353 

menthae piperitae, 376 
viridis, 378 

picis liquidae, 624 
Aquae medicatae, 53 
Aqueous fluid extract of senna, 96 
Argenti cyanidum, 741 

iodidum, 250, 742 

nitras, 742 

dilutus, 591, 742 
fusus, 742 

oxidum, 743 
Argonin, 746 
Aristol, 329 
Arnica, 771 

flores, 589 



Arnica flowers, 589 

plaster, 589 

radix, 589 

root, 589 
Aromatic bitters, 174 

powder, 363, 873 
of chalk, 156 
and opium, 156 

spirit of ammonia, 575 

sulphuric acid, 141 

syrup of rhubarb, 679 

tincture of rhubarb, 678 

waters — ofiicial, 53 
Aromatics, 359 
Arseni iodidum, 237 
Arsenic iodide, 237 

solutions, 54 

trioxide, 236 
Arsenious acid, 757 
Arsenous acid, 236 
Asafetida, 381, 704 
Asaprol, 322-324 
Asparagin hydrargyrate, 228 
Aspidium, 695, 697, 699 
Aspidosperma, 517 
Aspidospermine, 518 
Astringents, 710 
Atropa mandragora, 455 
Atropina, 454 
Atropinae sulphas, 455 
Atropine, 454 

compared with morphine, 459 

sulphate, 455 

Bacilli, 115 

Balsam of copaiba, 647 

of Peru, 339 

of tolu, 617, 620 
Balsamum Peruvianum, 339 

tolutanum, 620 

tranquillans, 119 
Bandages — antiseptic dressings, 127 
Barbadoes aloes, 674 
Barker's pills, 1 13 
Barley, 773 
Basham's mixture, 54 
Basic mercuric sulphate, 228 
Basilicon, 123 

Bateman's pectoral drops, 91 
Baths, 704 
Battery-fluid, 56 
Bay rum, 59 
Bearberry, 640 
Beef and wine, 85 

wine, and iron, 85 

wine, iron, and cinchona, 86 
Beer, 564 
Belladonna, 661 

leaves, 453 

liniment, 454 

ointment, 454 

plaster, 454 

root, 454 
Belladonnae folia, 453 



GENERAL INDEX. 



843 



Belladonnae radix, 454 
Benzoate of bismuth, 335 

of menthol, 335, 377 
Benzoated lard, 334 
Benzoic acid, 334 
Benzoin, 333 
Benzoinum, 333 
Benzonaphtol, 322, 323 
Benzosol, 312 
Benzoyl-eugenol, 370 
Benzoyl-sulphonic-imide, 657 
Bestucheft's tincture, 90 
Beta-naphtol, 322 
Betol, 323, 324 
Biniodide of mercury, 226 
Birch tar, 625 
Bismuth, 711 

and ammonium citrate, 751 

chrysophenate, 752 

citrate, 751 

naphtholate, 752 

salicylate, 752 

subcarbonate, 751 

subgallate, 752 

subiodide, 752 

subnitrate, 752 

tribromphenate, 752 
Bismuthi et ammonii citras, 75 1 

benzoas, 335 

citras, 751 

salicylas, 752 

subcarbonas, 75 1 

subiodidum, 752 

subnitras, 752 
Bitter wine of iron, 186 
Bitters, 172 
Black cohosh, 63 

draught, 83 

drop, 84 

haw, 73, 520 

mustard, 768 

oxide of manganese, 199 

pepper, 368 

wash, 228 
Blackberry, 725 

aromatic, 66 

cordial, 73 
Bland oils, 773 
Blaud's pills, III, 192 
Blistering cerate, 122 

collodion, 119, 764 

paper, 126 
Blood-root, 265 
Blue cohosh, 707 

flag, 680 

mass, 108, 224 

ointment, I2I, 224 

pill, 224 
Bolus, 115 
Bone-marrow, 222 
Boracic acid, 346 
Borax, 345, 704, 7o5 
Bougies, 124 
Boulton's solution, 56 



Brain-extract, 222 

Bran, 773 

Brandy, 59, 562 

Brayera, 701 

Bread, 773 

Bromide of iodine, 250 

Bromides, 529, 604 

Bromine, 758, 762 

Bromoform, 531 

Bromum, 762 

Broom, 551 

Brown mixture, 75, 623 

Brown-Sequard's antineuralgic pills, 112 

Buchu, 632, 639 

Buckthorn, 70 

berries, 66 
Burgundy pitch, 772 

-pitch plaster, 772 
Burnt alum, 747 
Butter of antimony, 757 
Butternut, 681 
Butyl-chloral hydrate, 424 

Cacao butter, 773 
Cactus, 554 
CafTeina, 556 

citrata, 556 

effervescens, 557 
Caffeine, 556 

citrate, 556 
Calabar bean, 510 
Calamus, 374 
Calcii bromidum, 530 

carbonas praecipitatus, 156 

hypophosphis, 206 

phosphas prsecipitatus, 206 

sulphocarbolas, 309 
Calcined magnesia, 158, 669 
Calcium bromide, 530 

hypophosphite, 206 

sulphocarbolate, 309 
Calendula, 173 
Calomel, 225, 661 

and jalap powder, 104 
Calumba, 173 
Calx, 761 

chlorata, 358 
Cambogia, 687 
Camphor, 382, 771 

ice, 123 

liniment, 383 

water, 383 
Camphora, 382 

carbolisata, 305 

monobromata, 383 
Camphorated carbolic acid, 305 

chloral, 412 

naphtol, 323, 324 

tincture of opium, 383, 430 
Camphoric acid, 383 
Canada liniment, n6 

-pitch plaster, 126 

snake-root, 63 
Cannabin tannate, 413 



844 



GENERAL INDEX. 



Cannabine tannate, 448 
Cannabinone, 448 
Cannabis Indica, 448 
Cantharidal collodion, 764 

pitch plaster, 772 
Cantharides, 704, 763, 764 

cerate, 764 
Cantharidis paper, 126 
Cantharis, 764 
Capsicum, 366, 771 

plaster, 367 
Caraway, 379 

Carbasus acidi carbolici, 304 
Carbolated oil, 304 
Carbolic acid, 304, 757 
Carbolic-acid gauze, 304 

plaster, 305 

water, 304 
Carbon tetrachloride, 410 
Cardamom, 372 
Cardamomum, 372 
Cardiac stimulants, 536 
Carron oil, 1 16 
Carum, 379 
Caryophyllus, 369 
Casca bark, 639 
Cascara sagrada, 72, 668 
Cascarilla, 175 
Cassia cinnamon, 363 

fistula, 666 
Castor oil, 667 
Catarrh snufif, 104 
Catechol, 325 
Catechu, 711, 717 
Cathartic acid, 683 
Cathartics, 658 
Cathartinic acid, 683 
Caulophyllum, 704, 707 
Caustic potash, 757, 759 

soda, 757, 759 
Caustics (escharotics), 127, 756 
Cayenne pepper, 366 
Celery compound, 68 
Cerata, 122, 123 
Cerate of lead subacetate, 727 
Cerates, 122 
Ceratum cantharidis, 764 

plumbi subacetatis, 727 
Cerii oxalas, 755 
Cerium oxalate, 711, 755 
Cerous oxalate, 755 
Cetraria, 773, 780 
Cevadilla, 583 
Ceylon cinnamon, 363 
Chalk mixture, 74 
Chalybeate pills. III, 192 
Chamomile, 174 
Channing's solution, 56 
Chapman's dinner pill, 112 

mixture, 76 
Charcoal, 774 
Charta potassii nitratis, 591 

sin apis, 769 
Chemical food, 65 



Chemical waters, official, 53 
Chenopodium, 695, 696 
Chinconidinge sulphas, 21 1 
Chinoidine, 212 
Chinoidinum, 212 
Chinolin, 212 

tartras, 212 

tartrate, 212 
Chirata, 174 
Chloral, 412, 604 
Chloral ammonium, 413 

butylicum, 424 

form amide, 422 

formidatum, 422 

glycerite, 412 

menthol, 377 

phenol, 412 

urethane, 413, 422 
Chloralamide, 422 
Chloralose, 413, 422 
Chlor- ammonium, 422 
Chloride of lime, 358 
Chlorinated lime, 358 
Chlorine water, 357 
Chlorodyne, 405 
Chloroform, 405, 771 

anodyne, 76 

emulsion, 405 

liniment, 405 

water, 405 
Chloroformum, 405 
Chlorohydrophosphate of lime, 63 
Cholera mixture, 76 
Chromic acid, 757, 758 

anhydride, 758 

trioxide, 758 
Churchill's iodine caustic, 57 

tincture of iodine, 90 
Cimicifuga, 63 
Cinchona, 209 

rubra, 210 
Cinchonidinse salicylas, 212 
Cinchonidine salicylate, 212 

sulphate, 211 
Cinchonina, 21 1 
Cinchoninae iodosulphas, 212 

sulphas, 211 
Cinchonine, 21 1 

iodosulphate, 329 

sulphate, 21 1 
Cinnamomum, 362 
Cinnamon, 362, 704 

water, 364 
Cinnamyl-eugenol, 370 
Citric acid, 149 
Citrine ointment, 228 
Clemens' solution, 57 
Cloves, 369 
Coca, 70, 490 
Cocaina, 491 
Cocainae hydrochloras, 491 

phenas, 491 
Cocaine, 491 

hydrochlorate, 491 



GENERAL INDEX. 



845 



Cocaine phenate, 491 
Cocculus, 475 
Indicus, 475 
Codeina, 431 
Codeine, 431 
Cod liver oil, 134, 704 
Cofifee, 64 
Colchicum, 256 
Cold cream, 121 
Cole's dinner pill, 112 
Collodia, official, 1 19 
Collodion, 774 
CoUodium stypticum, 712 

cantharidatum, 764 
Colocynth, 691 
Colocynthis, 691 
Colorless tincture of iodine, 90 
Colunibo, 173 

Comparative action of alkalies, 162 
Composition powder, 104 
Compound anise powder, 105 
cathartic pills, 687 
chalk powder, 156 
decoction of sarsaparilla, 263 
effervescing powder, 689 
extract of colocynth, 675, 691 
fluid extract of sarsaparilla, 263 

of stillingia, 265 
infusion of senna, 365, 670, 683 
iron mixture, 182, 338 
jalap powder, 692 
liniment of mustard, 769 
liquorice powder, 366 
mixture of glycyrrhiza, 623 
pills of antimony, 261 

of rhubarb, 676 
powder of glycyrrhiza 623, 683 
of jalap, 153 
of moi-phine, 431 
of rhubarb, 374 
rhubarb pills, 678 

powder, 678 
solution of iodine, 247 
spirit of aether, 399 

of juniper, 365, 366, 380, 642 
syrup of sarsaparilla, 263 
of squill, 607, 627, 637 
of stillingia, 265 
tincture of benzoin, 334-, 620, 676 
of cardamom, 363, 372, 380 
of catechu, 363 
of cinchona, 176, 211 
of gentian, 173 
of lavender, 363, 375 
Compressed pills, 115 
Confectio rosae, 725 

sennae, 365 
Confection of i-ose, 725 

of senna, 365, 683 
Confectiones, 106, 107 
Confections, 106 
Coniina, 500 

Coniinae hydrobromas, 500 
Coniine, 500 



Coniine hydrobromate, 496 
Conium, 500 

juice, 500 
Conserve of rose, 107 
Convallamarin, 555 
Convallamarinum, 555 
Convallaria, 555 
Convallarin, 555 
Copaiba, 632, 647 
Copper, 711 

sulphate, 739, 757 
Coriander, 364 
Coriandrum, 364 
Corn collodion, 120 
Corrosive chloride of mercury, 225 

mercuric chloride, 225 

sublimate, 225 
Cotton root bark, 484, 705 
Court plaster, 774, 782 
Coxe's hive syrup, 62 
Cramp bark, 521 
Cranesbill, 723 
Cream of tartar, 153 
Creasols, 305 
Creasote, 310 
Creosote water, 310 
Creosotum, 310 
Creta praeparata, 156 
Croton chloral, 424 

collodion, 120 

oil, 684, 763 
Cubeb, 651 
Cubeba, 650 
Culver's root, 682 
Cupri arsenis, 238 

sulphas, 739 
Cupric arsenite, 238 
Curagoa aloes, 674 

cordial, 67 
Curare, 515 
Cusso, 695, 696, 701 

Daley's carminative, 75 
Damiana, 73 
Dandelion, 671 
Decocta, 84 
Decoction of cetraria, 780 

of stillingia, 265 
Decoctions, 84 
Decoctum cetrariee, 780 

sarsaparillae compositum, 263 

stillingiae 265 
Demulcents, 773 
Denarcotized opium, 430 
Deodorant solution, 58 
Deodorized alcohol, 562 

opium, 430 
Dermatol, 752 
Dermol, 752 
Dewees' carminative, 77 

tincture of guaiac, 90 
Diachylon, 125 

ointment, 728 

plaster, 728 



846 



GENERAL INDEX. 



Dialyzed iron, 192 

Diaphoretics, 594 

Diethylendiamine, 656 

Diethyl-sulphon-diethyl-methane, 425 

Diethyl-sulphon-methyl-ethyl-methane, 425 

Digestants, 13 1 

Digitalin, 539 

Digitalinum, 539 

Digitalis, 539, 7^4 

Digitoxin, 540 

Diluted acetic acid, 149 

hydrobromic acid, 531 

hydrochloric acid, 140 

hydrocyanic acid, 521, 742 

hypophosphorous acid, 207 

nitric acid, 141 

nitrohydrochloric acid, 140, 141 

phosphoric acid, 140 

silver nitrate, 591, 742 

solution of lead subacetate, 727 

sulphuric acid, 141 
Dimethyl ether, 410 
Dinner pill, 1 1 1 
Disease medicines, 131 
Dispensatory, 26 
Dispermin, 656 
Dithymol di-iodide, 329 
Diuretin, 557, 632, 653 
Dobell's solution, 58, 305 
Donovan's solution, 54, 238 
Dover's powder, 103, 430 
Drastic purgatives, 691 
Dried alum, 747 

ferrous sulphate, 190 

sodium carbonate, 155 
Drugs, untovi^ard effects of, 34 
Dry acid wines, 564 
Dysmenorrhea mixture, 89 

EcBOLics, 704 

Effervescent Carlsbad salt, 106 

citrated caffeine, 557 

Kissingen salt, 106 

magnesium citrate, 688 

salts, 105 

Vichy salt, 106 
Effervescing saline water, 58 
Elaterin, 686 
Elaterinum, 686 
Electuar. sennse, 107 
Elixir aurantiorum compositum, 85 

calisaya, 69 

of paraldehyde, 428 

of phosphorus, 201 

paraldehydi, 428 

phosphori, 201 

purgans, 72 
Elixiria, 66-73 
Elixirs, 66 

adjuvant, 67 

medicinal, 68 
Elm, 780 
Emetics, 601 
Emmenagogues, 704 



Emollients, 773 
Emplastra, 124-126 
Emplastrum acidi carbolici, 305 

ammoniaci cum hydrargyro, 225, 382 

arnicse, 589 

belladonnge, 454 

capsici, 367 

ferri, 191, 772 

hydrargyri, 225 

ichthyocollae, 774, 782 

opii, 430, 772 

picis Burgundicse, 772 
cantharidatum, 764, 772 

plumbi, 728 
Emulsion of ammoniac, 382 

of asafetida, 381 
Emulsiones, 78-81 
Emulsions, 78 
Emulsum ammoniaci, 382 

asafoetidae, 381 

chloroformi, 405 

guaiaci, 261 
Epispastics, 763 
Epsom salt, 688 
Ergot, 478, 661, 704, 705 

of rye, 473 
Ergota, 478 
Ergotin, 479 

Erythrophleum, 632, 639 
Escharotics, 756 
Eserine salicylate, 510 

sulphate, 510 
Essence of ginger, 59 

of nutmeg, 369 

of peppermint, 376 

of spearmint, 378 

of wintergreen, 375 
Ether, 771 

Ethereal tinctures, 91 
Ethyl bromide, 409 

carbamate, 413 

chloride, 409 

iodide, 409 

urethane, 413 
Ethylene bichloride, 409 

bromide, 409 

chloride, 409 

iodide, 409 
Ethylenimine, 656 
Ethylidene chloride, 409 
Eucalyptol, 341 
Eucalyptus, 340 

water, 341 
Eugenol-acetamide, 370 
Euonymin, 680 
Euonymus, 680 
European hellebore, 583 
Europhen, 330 
Exalgine, 397 
Expectorants, 616 
Expressed oil of almond, 778 
Extract of aconite, 578 

of aloes, 675 

of arnica root, 589 



GENERAL INDEX. 



847 



Extract of cinchona, 211 

of colchicum root, 256 

of colocynth, 691 

of conium, 500 

of convallaria, 555 

of digitalis, 539 

of ergot, 478 

of euonymus, 680 

of gentian, 173 

of glycyrrhiza, 623 

of hematoxylon, 721 

of hyoscyamus, 464 

of iris, 681 

of jalap, 692 

of I'uglans, 682 

of krameria, 719 

of leptandra, 682 

of nux vomica, 467 

of opium, 430 

of pancreas, 222 

of physostigma, 510 

of podophyllin, 694 

of Pulsatilla, 588 

of quassia, 172 

of rhubarb, 678 

of taraxacum, 674 

of uva ursi, 641 
Extracta, 97 

fluida, 92-96 
Extractive preparations, 81 
Extracts, 97 

official, table of average doses, 98 
Extractum aconiti, 578 
fluidum, 578 

aloes, 675 

arnicse radicis, 589 
fluidum, 589 

aspidospermatis fluidum, 518 

belladonnae foliorum alcoholicum, 454 
radicis fluidum, 454 

cacti fluidum, 554 

calami fluidum, 374 

calendulae fluidum, 174 

calumbae fluidum, 173 

cannabis indicse, 448 
fluidum, 448 

capsici fluidum, 367 

chiratae fluidum, 174 

cinchonae, 211 
fluidum, 211 

cocae fluidum, 491 

cocculi fluidum, 476 

colchici radicis, 256 
fluidum, 256 
seminis fluidum, 257 

colocynthidis, 691 

compositum, 675, 691 

cpnii, 500 
fluidum, 500 

convallariae fluidum, 555 

cubebse fluidum, 651 

cusso fluidum, 701 

digitalis, 539 
fluidum, 539 



Extractum ergotae, 478 

fluidum, 479 
eucalypti fluidum, 340 
euonymi, 680 
gelsemii fluidum, 504 
gentianae, 173 

fluidum, 173 
geranii fluidum, 723 
glycyrrhiza;, 623 

fluidum, 623 
purum, 623 

gossypii radicis fluidum, 484 
grindelias fluidum, 508 
hematoxyli, 721 
hamamelidis fluidum, 721 
hydrastis fluidum, 485 
hyoscyami, 464 

fluidum, 464 
ipecacuanhae fluidum, 610 
iridis, 681 

fluidum, 681 
jalapae, 692 
juglandis, 682 

juniperi fructus fluidum, 642 
kramerias, 719 

fluidum, 719 
leptandras, 682 

fluidum, 682 
lobeliae fluidum, 615 
lupulini fluidum, 446 
mezerei fluidum, 269 
nucis vomicae, 467 
fluidum, 467 
opii, 430 

physostigmatis, 510 
phytolaccae radicis fluidum, 587 
pilocarpi fluidum, 594 
podophylli, 694 

fluidum, 694 
Pulsatillas, 588 
quassiae, 172 

fluidum, 172 
rhei, 678 

fluidum, 678 
rhois aromaticse fluidum, 724 

glabrae fluidum, 724 
rosae fluidum, 725 
rubi fluidum, 726 
sabinae fluidum, 705 
sanguinariae fluidum, 266 
sarsaparillas fluidum, 263 

compositum, 263 
scill^e fluidum, 637 
scoparii fluidum, 551 
senegee fluidum, 627 
sennae fluidum, 683 
serpentariae fluidum, 176 
spigeliae fluidum, 699 
stillingiae fluidum, 265 
compositum, 265 
stramonii seminis, 463 

fluidum, 463 
taraxaci, 674 

fluidum, 674 



848 



GENERAL INDEX, 



Extractum uvse ursi, 641 
fluidum, 641 
Valerianae fluidum, 384 
veratri viridis fluidum, 583 
viburni opuli fluidum, 521 

prunifolii fluidum, 520 
xanthoxyli fluidum, 270 
zingiberis fluidum, 373 

False hellebore, 554 
Fats and oils, 134 
Fehling's solution, 56 
Fel bo vis, 677 

purificatum, 677 

tauri, 677 
Fennel, 365 

water, 366 
Fenner's guaiac mixture, 89 
Ferrated extract of apples, 90 
Ferratin, 192 
Ferri albuminas, 192 

arsenas, 192 

carbonas saccharatus, 182 

chloridum, 183 

citras, 184 

et ammonii citras, 185 
sulphas, 188 
tai-tras, 188 

et potassii tartras, 188 

et quininae citras, 185 
solubilis, 186 

et strychninae citras, 186, 468 

hypophosphis, 189 

iodidum saccharatum, 183 

lactas, 187 

oxidum hydratum, 187 
cum magnesiae, 187 

phosphas solubilis, 188 

pyrophosphas solubilis, 1 89 

sulphas, 190 
exsiccatus, 190 
granulatus, 190 

valerianas, 189, 384 
Ferric ammonium sulphate, 188 

chloride, 183 

citrate, 184 

hydrate, 187 

with magnesia, 187 

hydroxide, 187 

hypophosphite, 189 

valerianate, 189, 384 
Ferrous chloride, 64 

lactate, 187 

sulphate, 190 
Ferruginous pills, III, 192 
Ferrum dialysatum, 192 

reductum, 181 
Figs, 773 
Fish berry, 475 
Flaxseed, 773 
Flour, 773 

Fluid extract of aconite, 578 
of arnica root, 589 
of aspidosperma, 518 



Fluid extract of belladonna root, 454 
of black haw, 520 
of cactus, 554 
of calamus, 374 
of calendula, 174 
of calumba, 173 
of capsicum, 367 
of chirata, 174 
of cinchona, 211 
of coca, 491 
of cocculus, 476 
of colchicum root, 256 

seed, 257 
of conium, 500 
of cotton-root bark, 484 
of cramp bark, 521 
of cubeb, 651 
of cusso, 701 
of digitalis, 539 
of ergot, 479 
of eucalyptus, 340 
of gelsemium, 504 
of gentian, 173 
of geranium, 723 
of ginger, 373 
of glycyrrhiza, 623 
of grindelia, 508 
of hamamelis, 72 1 
of hydrastis, 485 
of hyoscyamus, 464 
of Indian cannabis, 448 
of ipecacuanha, 610 
of iris, 681 

of juniper berries, 642 
of krameria, 719 
of leptandra, 682 
of lobelia, 615 
of lupulin, 446 
of mezereon, 269 
of nux vomica, 467 
of Phytolacca root, 587 
of pilocarpus, 594 
of podophyllum, 694 
of quassia, 172 
of rhubarb, 678 
of rhus aromatica, 724 

glabra, 724 
of rose, 725 
of rubus, 726 
of sanguinaria, 266 
of sarsaparilla, 263 
of savine, 705 
of scoparius, 551 
of senega, 627 
of senna, 683 
of serpentaria, 176 
of spigelia, 699 
of squill, 637 
of stillingia, 265 
of stramonium seed, 463 
of taraxacum, 674 
of uva ursi, 641 
of valerian, 384 
of veratrum viride, 583 



GENERAL INDEX. 



849 



Fluid extract of xanthoxylum, 270 
Fluid extracts, 92 
Fluorescein, 325 
Foeniculum, 305 
Fomentations, 127 
Formamidate of mercury, 228 
Formic ether, 410 
Fowler's solution, 54, 237 
Foxglove, 539 
Francis's triplex pill, 114 
" French mixture," 56 
Friable pills, 115 

Gadberry's mixture, 77 

Galbanum plaster, 126 

Galla, 711, 715 

Gallic acid, 711, 714 

Gamboge, 687 

Garlic, 617, 621 

Gastric sedatives, 603 

Gastrin, 222 

Gelatin, 773 

Gelsemina, 504 

Gelsemium, 504 

Gentian, 172 

Gentiana, 172 

Geranium, 711, 723 

Gin, 59, 563 

Ginger, 373 

Glacial acetic acid, 757, 760 

Glauber's salt, 690 

Globules, 114 

Glucusimide, 657 

Gluside, 657 

Glycerine, 661, 773, 774 

Glycerinum, 774 

Glycerita, 73, 74 

Glycerite of alum, 747 

of boroglycerin, 346 

of carbolic acid, 304 

of glyceryl borate, 346 

of hydrastis, 485 

of starch, 775 

of tannic acid, 712 

of tar, 625 

of yolk of egg, 775 
Glyceritum acidi carbolici, 304, 775 
tannici, 712, 775 

amyli, 775 

boroglycerini, 346, 775 

hydrastis, 485, 775 

picis liquidae, 625 

vitelli, 775 
Glycerole of pepsin, 74 
Glyconin, 775 
Glycyrrhiza, 622 

Glycyrrhizinum ammoniatum, 623 
Godfrey's cordial, 77 
Golden seal. 485 
Gossypii radicis cortex, 484 
Goulard's cerate, 123, 727 

extract, 727 
Granatum, 695, 696, 701 
Granulated ferrous sulphate, 190 

54 



Granules, 114 

Green iodide of mercury, 226 

Griffith's mixture, 74, 182 

Grindelia, 507, 617 

Gross' antineuralgic pills, 112 

Guaiac, 260, 704 

emulsion, 261 
Guaiaci lignum, 260 

resina, 260 
Guaiacol, 312 

benzoate, 312 

carbonate, 313 

di-iodide, 313 

salicylate, 313 
Guaiacoli benzoas, 312 

carbonas, 313 

di-iodidum, 313 

salicylas, 313 
Guaiacolum, 312 
Guaiacum wood, 260 
Guaramine, 557 
Gum Arabic, 779 

H^MALBUMIN, 193 

Hgemoferrum, 193 
Haemogallol, 192 
Haemoglobin, 193 
Haemol, 192 
Hall's dinner pill, 112 

solution of strychnine, 58 
Hamamelis, 711, 721 
Heart-extract, 222 
Hebra's ointment, 1 21 
Hedeoma, 704, 709 
Heliotropin, 368 
Hematics, 181, 704 
Hematoxylon, 711, 720 
Hemlock, 500 
Henbane, 464 
Hiera pi era, 104 
Hive syrup, 607 
Hoffmann's anodyne, 60, 399 
Homatropina, 455 
Honey, 773 
Hope's mixture, 75 
Hops, 445 
Hot drops, 90 
Humulus, 445 
Huxham's tincture, 88 
Hydragogue purgatives, 684 
Hydrargyri chloridum mite, 225 
corrosivum, 225 

cyanidum, 226 

form ami datum, 228 

iodidum flavum, 226 
rubrum, 226 
viride, 226 

oxidum flavum, 227 
rubrum, 227 

salicylas, 228 

subsulphas flavus, 228 

tannas, 228 
Hydrargyrum, 223 

ammoniatum, 224 



850 



GENERAL INDEX. 



Hydrargyrum cum creta, 156, 224 
Hydrastina, 485 
Hydrastinae hydrochloras, 4S5 
Hydrastine, 485 

hydrochlorate, 485 
Hydrastis, 485, 704, 7o5 
Hydrated oxide of iron, 187 
Hydrochloric acid, 140 
Hydrocyanic acid, 604 
Hydrogen peroxide, 53 
Hydroiiaphtol, 323, 324 
Hydroquinol, 325 
Hydroquinone, 325 
Hyoscinae hydrobromas, 464 
Hyoscine hydrobromate, 413, 464 
Hyoscyami sulphas, 465 
Hyoscyarainae hydrobromas, 465 
Hyoscyamine hydrobromate, 465 

sulphate, 465 
Hyoscyamus, 464, 661 
Hypnal, 413, 422 
Hypophosphite of iron, 64 

of lime, 63 
and soda, 63 

Ice, 603 

Iceland moss, 780 
Ichthyocolla, 782 
Ichthyol, 327 
Ichthyolum, 327 
Indian tobacco, 614 
Infusa, 83, 84 
Infused oils, 119 
Infusion of cinchona, 211 

of convallaria, 555 

of digitalis, 539 

of hops, 446 

of juniper, 642 

of pilocarpus, 594 

of wild cherry, 176 
Infusions, 83 
Infusum cinchonae, 211 

convallariae, 555 

digitalis, 539 

humuli, 446 

juniperi, 642 

pilocarpi, 595 

pruni Virginianae, 176 

sennse compositum, 365, 670, 683 
lodi bromidum, 250 

chloridum, 250 
Iodide of calcium, 63 

of iron and manganese, 64 
Iodine, 246, 763, 771 

caustic, 57 

chloride, 250 

ointment, 247 

trichloride, 250 
Iodized collodion, 1 20 

carbolic acid, 305 
Iodoform, 329 

collodion, 120 

and naphtalin powder, 1 04 
lodoformum, 329 



lodol, 330 
lodum, 246 
Ipecac, 610, 763 
Ipecacuanha, 602, 610, 617 
Iridin, 681 
Iris, 680 
Irish moss, 64 
Iron, 704 

and ammonium tartrate, 188 
citrate, 185 

and potassium tartrate, 188 

and quinine citrate, 185 

and strychnine citrate, 186 

arsenate, 192 

by hydrogen, 181 

plaster, 191 

quinine chloride, 193 

solutions, 54 
Isinglass, 773, 782 

plaster, 782 

Jaborandi, 71, 594 

Jaborine, 595 

Jackson's pectoral syrup, 65 

Jalap, 692 

Jalapa, 692 

James's powder, 103 

Jamestown weed, 462 

Janeway's pills, 112 

Javelle water, 57 

Jimson weed, 462 

Juglans, 681 

Juniper, 632, 641 

berries, 641 
Juniperus, 641 

Kamala, 695, 696, 702 
Kino, 711, 718 
Kosin, 701 
Koussein, 701 
Kousso, 701 
Krameria, 711, 719 

Labarraque's solution, 55, 358 

Lac sulphur, 671 

Lactic acid, 146 

Lactophosphate of lime with iron, 64 

of iron, 64 
Lactucarium, 447 
Lady Webster's dinner pills. III 
Lafayette mixture, 76 
Lamellae, 115 
Lard, 773 
Laudanum, 430 
Laughing gas, 41 1 
Laxative elixir, 72 
Laxatives, 666 
Lead, 711, 726 

acetate, 726 

carbonate, 727 

iodide, 249, 727 

nitrate, 728 

oxide, 728 

plaster, 728 



GENERAL INDEX. 



851 



Lead water, 55, 727 
Leeches, 704 
Leptandra, 682 
Leptandrin, 682 
Levant wormseed, 697 
Light magnesia, 158, 669 

red wines, 564 
Lignum vit^, 260 
Lily of the valley, 555 
Lime, 757, 761 
juice and pepsin, 73 
liniment, 157 
water, 55, 157 
Liniment of lead subacetate, 727 
Linimenta, 116, 117 
Liniments, 116 
Linimentum album, 117 
ammonise, 575 
belladonnse, 454 
calcis, 157 
camphorge, 383 
chloroformi, 405 
plumbi subacetatis, 727 
saponis, 383 

sinapis compositum, 769 
Linseed meal, 773 

oil, 773, 779 
Liquid, mixtures — internal, 74 

rennet, 58 
Liquor acidi arsenosi, 237 
ammonii acetatis, 598 
antimonii chloridi, 757 
arseni bromidi, 238 
arsenii bromidi, 57 
et auri bromidi, 238 
et hydrargyri iodidi, 227, 238 
calcis, 157 
ferri acetatis, 184 
chloridi, 184 
citratis, 185 
dialysatus, 192 

et ammonii acetatis, 184, 599 
nitratis, 19I 
oxychlorati, 192 
peptonati, 192 
subsulphatis, 190 
tersulphatis, 191 
hydrargyri nitratis, 228 
iodi compositus, 247 
magnesii citratis, 688 
mangano- ferri peptonatus, 192 
plumbi subacetatis, 727 

dilutus, 727 
potassse, 152 

arsenitis, 237 
sedans, 520 
sodse, 154 

chlorate, 358 
sodii arsenatis, 238 

boratis compositus, 305 
carbolfltus, 305 
Liquores, 53 

unofficial, 55-59 
Liquorice, 65, 617, 622, 773 



Liquorice root, 622 

Litharge, 728 

Lithii bromidum, 530 

benzoas, 335 

carbonas, 157 

citras, 157 

eftervescens, 158 

salicylas, 315 
Lithium benzoate, 335 

bromide, 530 

carbonate, 157 

citrate, 157 

salicylate, 315 
Lobelia, 602, 607, 614 
Local anti-emetics, 603 
Logwood, 720 

Loomis's diarrhea mixture, 76 
Losophene, 330 
Lotio flava, 228 

nigra, 228 
Lotiones, 117, 118 
Lugol's solution, 55 
Lunar caustic, 742 
Lupulin, 445 
Lupulinum, 445 
Lycopodium, 774, 783 
Lysol, 625 

Mace, 368 

Macis, 368 

Magendie's solution of morphine, 57 

Magnesia, 661, 669 

Magnesii carbonas, 158, 670 

sulphas, 688 

efifervescens, 688 

sulphocarbolas, 309 
Magnesium carbonate, 158, 661, 670 

sulphate, 688 

sulphocarbolate, 309 
Male fern, 699 
Mandrake, 455 
Manganese, 199 

dioxide, 199 

sulphate, 199 
Mangani dioxidum, 199 

sulphas, 199 
Manganum, 199 
Manna, 670 
Marigold, 173 
Marshmallow, 773, 781 
Mass of copaiba, 648 

of ferrous carbonate, 182 

of mercury, 224 
Massa ferri carbonatis, 182 

copaibae, 648 

hydrargyri, 224, 775 
Massse, 108 
Masses, 108 
May apple, 694 
Meadow-saffron, 256 
Medicated cottons, 128 

dressings, 128 

gauzes — carbasa, 128 

waters, 53 



8.S2 



GENERAL INDEX. 



Medicines, administration of, 29 

classification of, 24 

disease, 26 

dosage, 31 

symptom, 26 
Medullin, 222 
Mentha piperita, 376 

viridis, 377 
Menthol, 377, 771 

benzoas, 335 
Mercurial ointment, 224 

plaster, 225 
Mercuric chloride, 757 

cyanide, 226 

nitrate, 757 

oxide, 757 
Mercurous salicylate, 228 

tannate, 228 
Mercury, 223 

with chalk, 156, 224, 662 
Metallorum amarae, 114 
Methyl chloride, 409 
Methylacetanilide, 397 
Methylal, 410 
Methylen, 410 
Methylene bichloride, 409 
Methylic ether, 410 
Metric system, 44 
Mezereon, 268, 763, 771 
Mezereum, 268 
Mild chloride of mercury, 225 

mercurous chloride, 225 
Milk of sulphur, 67 1 
Mineral acids, 139, 757 

astringents, 711, 726 

waters, 167 
Mistura antidysenterica, 75 

ferri composita, 182, 338 

glycyrrhizae composita, 623 

opii alkalina, 77 

rhei et sodae, 155, 678 

solvens simplex, 75 
Misturae, 74-78 
Mitigated caustic, 742 
Mixture of chloral and bromide, 75 

of rhubarb, and soda, 155, 678 
Monobromated camphor, 383 
Monsel's solution, 54, 190 
Morphina, 431 
Morphinse acetas, 431 

hydrochloras, 431 

sulphas, 431 
Morphine, 661 

acetate, 431 

hydrochlorate, 431 

sulphate, 431 
Mother's salve, 122 
Motor excitants, 466 
Moulded silver nitrate, 742 
Mucilage of acacia, 779 

of elm, 781 

of sassafras pith, 782 

of tragacanth, 782 
Mucilages, 74 



Mucilagines, 74 
Mucilago acaciae, 779 

sassafras medullae, 782 

tragacanthae, 775, 782 

ulmi, 781 
Muriatic acid, 140 
Muscarine, 661 
Muscle-extract, 222 
Mustard, 704, 768, 771 

paper, 769 

volatile oil, 763 
Myristica, 368 
Myrrh, 338, 704 
Myrrha, 338 

Naphtalin, 322, 324 

Naphtalinum, 322, 324 

Naphtol, 322, 324 

Naphtosalol, 323 

Native mineral springs, list of, 170 

Neutral mixture, 54 

Nitre, 591 

Nitric acid, 141 

Nitroglycerin, 525, 604 

pills, 113 
Nitrohydrochloric acid, 140, 141 
Nitrous oxide, 41 1 
Nuclein, 221 
Nutgall, 715 
Nutmeg, 368 
Nux vomica, 467, 66l 

Oatmeal, 773 
Official — officinal, 23 
Oil of allspice, 371 

of American wormseed, 696 

of anise, 361 

of cade, 625 

of cajuput, 371, 11\ 

of caraway, 380 

of chenopodium, 696 

of cinnamon, 363 

of cloves, 370 

of copaiba, 648 

of coriander, 365 

of cubeb, 651 

of eucalyptus, 340 

of fennel, 366 

of flaxseed, 779 

of hedeoma, 709 

of juniper, 641 

of lavender flowers, 375 

of nutmeg, 369 

of pennyroyal, 709 

of peppermint, 376 

of pine, 624 

of rue, 705, 707 

of sandalwood, 650 

of savine, 705 

of Scotch fir, 617, 624 

of tar, 624 

of turpentine, 771 

of wintergreen, 375 
Ointment of ammoniated mercury, 224 



GENERAL INDEX. 



853 



Ointment of carbolic acid, 304 

of iodoform, 329 

of lead carbonate, 727 
iodide, 728 

of mercuric nitrate, 228 

of potassium iodide, 248 

of red mercuric oxide, 227 

of sulphur iodide, 249 

of tannic acid, 712 

of yellow mercuric oxide, 227 

of zinc oxide, 735 
Oleata, official, 118 

unofficial, 1 19 
Oleate of aconite, 579 

of sodium, 58 

of veratrine, 583 
Oleates, 118, 119 
Oleatum aconitinae, 579 

veratrinae, 583 
Oleoresin of aspidium, 699 

of capsicum, 367 

of cubeb, 651 

of ginger, 373 

of lupulin, 446 

of pepper, 368 
Oleoresma aspidii, 699 

capsici, 367 

cubebse, 651 

lupulini, 446 

piperis, 368 

zingiberis, yjT) 
'01eoresin?e, 99 
Oleoresins, 99 
vOleum acidi carbolici, 304 

amygdalae expressum, 778 

anisi, 361 

cadinum, 625 

cajuputi, 371 

cari, 380 

caryophylli, 370 

chenopodii, 696 

cinnamomi, 363 

copaibse, 648 

coriandri, 365 

cubebae, 651 

eucalypti, 340 

foeniculi, 366 

gaultheriae, 375 

iiedeoma, 709 

juniperi, 641 

lavandulae florum, 375 

lini, 779 

Tiienthae piperitee, 376 

morrhuae, 134 

myristicre, 369 

•olivae, 777 

phosphoratum, 201 

picis liquidae, 624 

pimentae, 371 

pini sylvestris, 617, 624 

ricini, 667 

rusci, 625 

Tutae, 707 

;sabinae, 785 



Oleum santali, 650 

sinapis volatile, 769 

templinum, 624 

tiglii, 684 
Olive oil, 773, 777 
Onion, 617, 621 
Opii pulvis, 430 
Opium, 431, 604 

compared with its alkaloids, 444 

deodoratum, 430 

plaster, 430 
Opodeldoc, 117 
Organotherapy, 219 
Orthodioxybenzene, 325 
Ouabain, 549 
Ovarin, 222 
Oxgall, 677 
Oxysulphate of iron, 56 
Oxytocics, 704 

Pancreatic solution, 57 
Pancreatin, 133 
Pancreatinum, 133 
Papain, 133 
Papers, 126 
Paradioxybenzene, 325 
Paraffin, 773 
Paraldehyde, 427 
Paraldehvdum, 427 
Paregoric, 88, 430 
Parrislrs camphor mixture, 75 
Parsley, 708 
Parvules, 114 
Pearson's solution, 238 
Pelletierinae tannas, 702 
Pelletierine, 702 

tannate, 702 
Pennyroyal, 709 
Pental, 410 
Pepo, 695, 696, 703 
Pepper, 368 
Peppermint, 376 
Pepsin, 131 
Pepsinum, 131 

saccharatum, 132 
Peptonizing powder, 104 
Petrolatum, 773 
Petroleum, 773 
Petroselinum, 708 
Pharmaceutical preparations, 5 1 
Pharmacology, 21 
Pharmacopoeia, 23 
Pheasant's eye, 554 
Phenacetin, 395 
Phenocoll, 396 
Phenol-camphor, 305 

iodatum, 305 

-sodique, 58, 305 
Phenyl salicylate, 320 
Phosphatic emulsion, 81 
Phosphorated oil, 201 
Phosphoric acid, 140 
Phosphorus, 200 
Physostigma, 510, 661 



854 



GENERAL INDEX. 



Physostigminae hydrobromas, 511 
salicylas, 510 
sulphas, 510 
Physostigmine hydrobromate, 511 
salicylate, 510 
sulphate, 510 
Phytolacca fruit, 586 

root, 586 
Phytolaccae fructus, 586 

radix, 586 
Picrotoxin, 476 
Picrotoxinum, 476 
Pills, 109 
of aloes, 675 

and asafetida, 381, 675 
and iron, 191, 675 
and mastich, 675 
and myrrh, 338, 675 
of asafetida, 381 
of ferrous carbonate, 192 

iodide, 183 
of opium, 430 
of phosphorus, 201 
of rhubarb, 678 
Pilocarpinge hydrochloras, 594 
Pilocarpine, 594, 661, 705 

hydrochlorate, 594 
Pilocarpus, 594, 617 
Pilulae, 109-114 
aloes, 675 

et asafoetidae, 381, 675 
et ferri, 191, 675 
et mastiches, 675 
et rayrrhge, 338, 675 
antimonii compositse, 261 
asafoetidae, 381 
catharticse compositae, 687, 691, 692 

vegetabiles, 682, 691, 692 
Cochia, 113 
ferri carbonatis, 192 

et quininse compositae, 1 14 
iodidi, 183 
hydrargyri, 224, 662 
official. III 
opii, 430 

phosphori, 201, 775 
rhei, 678 

compositae, 676, 678 
unofficial, 111-I14 
Pimenta, 371 
Pinkroot, 699 
Piper, 368 
Piperazidine, 656 
Piperazinum, 656 
Piperin, 368 
Piperinum, 368 
Piperonal, 368 
Pitch, 771 
Pix betulae, 625 
Burgundica, 772 
liquida, 624 
Pixol, 625 
Plaster-mull, 127 
PI aster-of- Paris bandages, 129 



Plasters, 124 
Plumbi acetas, 726 

carbon as, 727 

iodidum, 249, 727 

nitras, 728 

oxidum, 728 
Plumbum, 726 
Plummer's pills, ill, 261 
Podophyllotoxin, 694 
Podophyllum, 694 
Poison ivy, 488 
Poke root, 586 
Pomegranate, 701 
Port wine, 563 
Porter, 564 
Potassa, 759 

and lime, 757 

with lime, 759 
Potassii acetas, 152 

bicarbonas, 152 

bichromas, 350 

bitartras, 153 

bromidum, 529 

carbon as, 153 

chloras, 351 

citras, 153 

cyanidum, 525 

et sodii tartras, 689 

hypophosphis, 207 

iodidum, 248 

nitras, 591 

permanganas, 348 

sulphas, 688 

sulphocarbolas, 309 

tartras, 154 
Potassio-ferric tartrate, 188 
Potassium acetate, 152 

and sodium tartrate, 689 

bicarbonate, 152 

bichromate, 350 

bitartrate, 153, 661 

bromide, 529 

carbonate, 153 

chlorate, 351 

citrate, 153 

cum calcii, 759 

cyanide, 525 

hydrate, 759 

hydroxide, 759 

hypophosphite, 207 

iodide, 248, 617 

nitrate, 591 
paper, 591 

permanganate, 348, 7^5 

sulphate, 688 

sulphocarbolate, 309 

tartrate, 154, 661 
Poultice (cataplasm), 127 
Powder of ipecac and opium, 430, 611 
Powdered opium, 430 
Powders, 102 

unofficial, 103 
Precipitated calcium carbonate, 156 
phosphate, 206^ 



GENERAL INDEX. 



855 



Precipitated sulphur, 671 

zinc carbonate, 735 
Preparations for external use, 1 15 
of ammonium, I'iS 
of calcium, 156 
of iron, 181 
of lithium, 157 
of magnesium, 158 
of sodium, 154 
Prepared chalk, 156 
Prescription-writing, 798 
Prescriptions, 784 
Prickly ash, 270 
Proof spirit, 563 
Protective agents, 773 
Protoxide of mercury, 226 
Prunus Virginiana, 175 
Prussic acid, 521, 742 
Pulsatilla, 588 
Pulveres, 102-105 
Pulvis aromaticus, 363, 373 
cretae aromaticus, 156 
cum opio, 156 
compositus, 156 
digest! vus, 104 
effervescens compositus, 689 
glycyrrhizae compositus, 366, 623, 683 
ipecacuanhae et opii, 430, 611 
jalapse compositus, 153, 692 
morphinas compositus, 431 
rhei compositus, 374, 678 
Pumpkin seed, 702 
Purging cassia, 666 
Purified aloes, 675 
cotton, 774 
oxgall, 677 
Pyrocatechin, 325 

Quassia, 172 
Quebrachine, 518 
Quebracho, 617 
Queen's root, 264 
Quercus alba, 711, 716 
Quevenne's iron, i8i 
Quicksilver, 223 
Quinetum, 212 
Quinidinas sulphas, 211 
Quinidine sulphate, 211, 212 
Quininje bisulphas, 211 

hydrobromas, 21 1 

hydrochloras, 212 
carbamidata, 213 

sulphas, 212 

valerianas, 212 
Quinine, 211, 704, 705 

bisulphate, 21 1 

hydrobromate, 21 1 

hydrochlorate, 212 

valerianate, 212 
Quinolin, 212 

Rectified spirit, 563 
Red cinchona, 210 

iodide of mercury, 226 



Red mercuric iodide, 226, 227 

precipitate, 227 

rose, 725 

wine, 563 
Reduced iron, 181 
Remedies, 21 
Renin, 222 
Resin of copaiba, 648 

of jalap, 692 

of podophyllum, 694 

of scammony, 693 
Resina copaibse, 648 

jalapse, 692 

podophylli, 694 

scammonii, 693 
Resin?e, 100 
Resins, 100 
Resopyrine, 325 
Resorcin, 325 
Resorcinum, 325 
Restoratives, 131 
Rhamnus Purshiana, 668 
Rhatany, 719 
Rheum, 677 
Rhubarb, 677 
Rhus aromatica, 724 

glabra, 71 1, 724 

toxicodendron, 488, 763 
Rochelle salt, 689 
Rosa gallica, 711, 725 . 
Rottlera, 702 
Rotulae, 115 
Rubefacients, 771 
Rubi compositum, 72 
Rubus, 711. 725 
Rue, 704, 706 
Rum, 563 
Ruta, 706 

vSabina, 705 

Saccharated ferrous iodide, 183 

carbonate, 182 
Saccharin, 657 
Saccharine substances, 617 
Saccharinum, 657 
Sales effervescentes, 103 



Salicinum, 321 

Salicylated powder of talcum, 105 
Salinaphtol, 323 
Salol, 320 
j Saltpetre, 591 
Sanguinaria, 265 
Sanguinarine nitrate, 266 
Santonica, 695, 697 
Santonin, 697 
Santoninum, 697 
Saponin, 617 
Sarsaparilla, 263 
Sassafras medulla, 782 

pith, 773, 782 
Savine, 704, 705 
Scammonium, 693 
Scammony, 693 



856 



GENERAL INDEX. 



Scilla, 636 
Scoparine, 552 
Scoparius, 551 
Scopola carniolica, 455 

japonica, 455 
Sebadilla, 583 
Seidlitz powder, 103, 689 
Senega, 617, 627 
Senna, 682 
aromatic, 66 
compound, 66 
Serpentaria, 176 
Serum-therapy, 271 
Sherry wine, 563 
Silver, 711 
cyanide, 741 
iodide, 250, 742 
nitrate, 742, 757, 763 
oxide, 743 
Simple bitters, 172 
cerate, 122 
purgatives, 674 
Sinapis alba, 768 

nigra, 768 
Slippery elm, 773, 780 
Smith's solution of bromine, 55 
Soap liniment, 383, 773 
Socotrine aloes, 675 
Soda, 759 
mint, 77 
Sodii acetas, 154 
arsenas, 238 
benzoas, 335 
bicarbonas, 154 
bisulphis, 356 
boras, 345 
bromidum, 529 
carbonas, 155 

exsiccatus, 155 
hypophosphis, 206 
hyposulphis, 356 
iodidum, 248 
nitras, 593 
nitris, 527 
phosphas, 689 
salicylas, 315 
sulphas, 690 
sulphis, 356 
sulphocarbolas, 309 
Sodio-salicylate of theobromine, 653 
Sodio-theobromine salicylate, 557 
Sodium acetate, 154 
arsenate, 238 
benzoate, 335 
bicarbonate, 154 
bisulphite, 356 
borate, 345 
bromide, 529 
carbonate, 155 
hydrate, 759 
hydroxide, 759 
hypophosphite, 206 
hyposulphite, 356 
iodide, 248 



Sodium nitrate, 593 
nitrite, 527 
orthophosphate, 689 
phosphate, 689 
salicylate, 315 
sulphate, 690 
sulphite, 356 
sulphocarbolate, 309 
Solid mixtures, internal use, lOi 

opodeldoc, 117 
Soluble ferric phosphate, 188 

pyrophosphate, 189 
iron and quinine citrate, 186 
saccharated iron, 65 
Solution of ammonium acetate, 598 
of antimony chloride, 757 
of arsenic and gold bromide, 238 
and mercuric iodide, 227, 238 

bromide, 237 
of arsenous acid, 237 
of basic ferric sulphate, 190 
of boroglyceride, 346 
of calcium hydrate, 157 
of chlorinated lime, 358 

potassa, 57 
of ferric acetate, 184 

chloride, 184 

citrate, 185 

nitrate, 191 

subsulphate, 190 

sulphate, 191 
of ferrous chloride, 56 
of gutta percha, 774 
of hydrogen dioxide, 353 
of iodide of mercury and potassium, ^6 
of iron and ammonium acetate, 184, 

599 

of lead subacetate, 727 

of lime, 157 

of magnesium citrate, 688 

of mercuric nitrate, 228 

of oxysulphuret of calcium, 56 

of peptonate of iron, 192 
and manganese, 192 

of potash, 152 

of potassium arsenite, 237 

of saccharin, 57 

of soda, 154 

of sodium arsenate, 238 
hydrate, 154 
silicate, 774 
Solutions, 53 

of metallic compounds, 55 
Sozal, 748 
Sozoiodol, 330 
Spanish flies, 764 
Sparkling wines, 563 
Sparteinse sulphas, 552 
Sparteine sulphate, 552 
Spearmint, 377 

water, 378 
Spermaceti, 773 
Spice plaster, 126 
Spigelia, 695, 696, 699 



GENERAL INDEX. 



857 



Spirit of ammonia, 574 

of anise, 362 

of camphor, 383 

of chloroform, 405 

of cinnamon, 364 

of ether, 399 

of gaultheria, 375 

of glonoin, 527 

of juniper, 642 

of lavender, 375 

of nitroglycerin, 527 

of nitrous ether, 600 

of nutmeg, 369 

of peppermint, 376 

of phosphorus, 201 

of soap, 60 

of spearmint, 378 
Spirits, 59, 60 
Spiritus aetheris, 399 
compositus, 399 
nitrosi, 600 

ammonioe, 574 

aromaticus, 159, 575 

anisi, 362 

aurantii compositus, 363 

camphorse, 383 

chloroformi, 405 

cinnamomi, 364 

frumenti, 562 

gaultheriae, 375 

glonoini, 527 

juniperi, 642 

compositus, 365, 366, 380, 642 

lavandulae, 375 

menthae piperitae, 376 
viridis, 378 

Mindererus, 54 

myristicge, 369 

phosphori, 201 

rectificatus, 563 

vini gallici, 562 
Spleen-mixture, 77 
Spongiopiline, 127 
Squibb's diarrhea mixture, 76 

podophyllum pills, 114 

rhubarb mixture, 77 
Squill, 632, 636 
Starch, 773 
Stillingia, 264 

comp., 96 
St. John Long's liniment, 1 17 
Stokes's expectorant, 77 

liniment, 117 
Stramonii folia, 462 

semen, 463 
Stramonium, 661 

leaves, 462 

seed, 463 
Strengthening plaster, 125, 191 
Stronger ammonia v^^ater, 574 
Strontii bromidum, 530 

iodidi, 248 
Strontium bromide, 530 

iodide, 248 



Strophanthin, 549 
Strophanthus, 548 
Strychnine, 467, 661, 704 
Styptic collodion, 712 
Sublimed sulphur, 671 
Succus conii, 500 
Sugar of lead, 726 
Sulphaminol, 330 
Sulphonal, 425 
Sulphur iodide, 249 

lotum, 671 

ointment, 671 

prsecipitatum, 671 

sublimatum, 671 
Sulphuric acid, 140 
Sulphuris iodidum, 249 
Sulphurous acid, 355 
Sumach, 724 
Sumbul, 519 
Sun mixture, 76 
Suppositoria, 123, 124 

glycerin i, 775 
Suppositories, 123 

of glycerin, 775 
Sweet flag, 374 

spirit of nitre, 60, 600 

sumach, 724 

tincture of rhubarb, 89, 678 

wines, 564 
Syrup of acacia, 780 

of althaea, 781 

of calcium lactophosphate, 1 47 

of citric acid, 149 

of Dover's powder, 65 

of ferrous iodide, 183 

of garlic, 621 

of ginger, 374 

of hydriodic acid, 247 

of hypophosphites, 207 
with iron, 187, 207 

of ipecac, 611 

of lactucarium, 447 

of morphine, 65 

of phosphates of iron, quinine, and 
strychnine, 187 

of rhubarb, 678 

of senega, 627 

of senna, 683 

of squill, 637 

of tar, 624 

of tolu, 620 

of wild cherry, 176 
Syrups, 60 
Syrupus acaciae, 780 

acidi citrici, 149 
hydriodici, 247 

allii, 621 

althaese, 781 

calcii lactophosphatis, 147 

corrigens, 64 

ferri iodidi, 183 

quininae, et strychninae phosphatum, 
187,468 

hypophosphitum, 207 



858 



GENERAL INDEX. 



Syrupus hypophosphilum cum ferro, 187, 
207 

ipecacuanhae, 61 1 

krameria, 719 

lactucarii, 447 

picis liquidae, 624 

pruni Virginianae, 176 

rhei, 678 

aiomaticus, 679 

sarsaparillae compositus, 26o, 362 

scillse, 637 

compositus, 607, 627, 637 

senegae, 627 

sennae, 683 

stillingiae compositus, 265 

tolutanus, 620 

zingiberis, 374 
Systemic anti-emetics, 604 

Tanacetum, 708 
Tannic acid, 711, 712 
Tansy, 704, 708 
Tar, 74,617 

alkaline, 57 

compound ointment, 122 

mixture, 77 

ointment, 624 

water, 624 
Taraxacum, 671 
Tartar emetic, 606, 763 
Tartaric acid, 149 
Tartrated antimony, 606 
Tasteless syrup of iodide of iron, 64 

tincture of iron, 90 
Terebene, 617, 629 
Terebenum, 629 
Terpene hydrate, 617 
Terpin hydrate, 630 
Terpini hydras, 630 
Terpinol, 630 
Tetrochlormethane, 410 
Tetronal, 425 
Theine, 557 
Theobromine, 557 
Therapeutics, 22 
Thielmann's mixture, 76 
Thioform, 752 
Thiol, 327 
Thiolum, 327 
Thioresorcin, 325 

Thompson's solution of phosphorus, 57 
Thorn apple, 462 
Thymacetin, 378 
Thymol, 378 
Tinctura aconiti, 578 

aloes, 676 

and myrrhae, t^i^, 676 

arnicae florum, 689 
radicis, 590 

asafoetidae, 381 

belladonnae foliorum, 454 

benzoini, 334 

composita, 334, 620, 676 

cacti, 554 



Tinctura calendulae, 174 
calumbse, 173 
cannabis indicae, 448 
cantharidis, 764 
capsici, 367 
cardamomi, 372 

composita, 363, 372, 380 
catechu composita, 363, 717 
chiratae, 174 
cinchonse, 211 

composita, 176, 211 
cinnamomi, 363 
cocculi, 476 
colchici seminis, 257 
conii, 500 
cubebae, 651 
digitaUs, 539 
ergotae, 479 
eucalypti, 341 
ferri acetatis, 192 

chloridi, 184 
gallae, 715 

gentianae composita, 173 
guaiaci, 261 

ammoniata, 261 
humuli, 446 
hydrastis, 485 
hyoscyami, 464 
iodi, 247 

ipecacuanhae et opii, 430, 61 1 
kino, 718 
krameriae, 719 
lactucarii, 447 

lavandulffi composita, 363, 375 
lobeliae, 615 
nucis vomicae, 467 
opii, 430 

camphorata, 362, 383, 430 

deodorati, 430 
physostigmatis, 510 
pulsatillae, 588 
quassiae, 172 
rhei, 678 

aromatica, 678 

dulcis, 678 
rhois toxicodendri, 489 
sanguinariae, 266 
scillae, 637 
serpentariae, 176 
stillingiae, 265 
stramonii seminis, 463 
strophanthi, 549 
sumbul, 519 
tolutana, 620 
Valerianae, 384 

ammoniata, 384 
veratri viridis, 583 
zingiberis, 374 
Tincture of aconite, 578 
of aloes, 676 

and myrrh, 338, 676 
of arnica flowers, 589 

root, 590 
of asafetida, 381 



GENERAL INDEX. 



859 



Tincture of belladonna leaves, 454 

of benzoin, 334 

of cactus, 554 

of calendula, 174 

of calumba, 173 

of cantharides, 764 

of capsicum, 367 

of cardamom, 372 

of chirata, 174 

of cinchona, 211 

of cinnamon, 363 

of cocculus. 476 

of colchicum seed, 257 

of conium, 500 

of cubeb, 651 

of cudbear, 91 

of deodorized opium, 430 

of digitalis, 539 

of Dover's powder, 430 

of ergot, 479 

of eucalyptus, 341 

of ferric acetate, 192 
chloride, 184 

of ginger, 374 

of guaiac, 261 

of hops, 446 

of hydrastis, 485 

of hyoscyamus, 464 

of Indian cannabis, 448 

of iodine, 247 

of ipecac and opium, 430^ 61 1 

of kino, 718 

of krameria, 719 

of lactucarium, 447 

of lobelia, 615 

of lupulin, 446 

of nutgall, 715 

of opium, 430 

of phosphorus, 201 

of physostigma, 510 

of poppy, 91 

of Pulsatilla, 588 

of quassia, 172 

of rhubarb, 678 

of rhus toxicodendron, 489 

of serpentaria, 176 

of squill, 637 

of stillingia, 265 

of stramonium seed, 463 

of strophantbus, 549 

of sumbul, 519 

of tolu, 620 

of valerian, 384 

of veratrum viride, 583 
Tinctures, 86 
Tolu, soluble, 92 
Topical remedies, 756 
Tragacanth, 773, 781. 
Tragacantha, 781 
Trional, 425 
Triplex pills, 1 14 
Trituratio elaterini, 686 
Trituration of elaterin, 686 
Troches, 107 



Troches of ammonium chloride, 618 

of catechu, 717 

of chalk, 156 

of cubeb, 651 

of ginger, 374 

of ipecac, 611 

of iron, 191 

of krameria, 719 

of liquorice and opium, 430 

of morphine and ipecac, 431, 611 

of peppermint, 376 

of potassium chlorate, 351 

of santonin, 697 

of sodium bicarbonate, 155 

of tannic acid, 712 
Trochisci acidi tannici, 712 

ammonii chloridi, 618 

catechu, 717 

cretae, 156 

ferri, 191 

glycyrrhizae et opii, 362. 430 

ipecacuanhae, 61 1 

kramerise, 719 

menthts piperitae, 376 

morphinae et ipecacuanhae, 431, 61: 

potassii chloratis, 351 

santonini, 697 

sodii bicarbonatis, 155 

zingiberis, 374 
Tulley"s powder, 103 
Tumenol, 328 
Tumenolum, 328 
Turlington's balsam, 87 
Turner's cerate, 122 
Turpentine, 632 
Turpeth mineral, 228 

Ulmus, 780 
Unguenta, 1 20-1 22 
Unguentum acidi carbolici, 304 
tannici, 712 
belladonnas, 454 
camphoratum, 122 
diachylon, 728 
hydrargyri, 224 
ammoniati, 224 
nitratis, 228 
oxidi flavi, 227 
rubri, 227 
iodi, 247 
iodoformi, 329 
matris, 122 
picis liquidae, 624 
plumbi carbonatis, 727 

iodidi, 728 
potassii iodidi, 248 
stramonii, 463 
sulphuris, 671 
iodidi, 249 
veratrinae, 583 
zinci carbonatis impuri, 122 
oxidi, 735 
Ural, 413, 422 
Uralium, 413 



86o 



GENERAL INDEX. 



Urea, 632 

Urethane, 413, 420 
Ustilago, 705 
Uva ursi, 632, 640 

Valerian, 383 
Valeriana, 383 
Vallet's mass, 108, 182 
Vaseline 773 
Vegetable acids, 148 

astringents, 711 
Velpeau's diarrhea mixture, 76 
Veratrina, 583 
Veratrine, 583 

ointment, 583 
Veratrum album, 583 

viride, 582 
Vermicides, 695 
Vermifuges, 695 
Vesicants, 763 
Viburnum opulus, 521 

prunifolium, 520 
Vienna caustic, 759 

paste, 759 
Villate's solution, 75 
Vina, 84-86 
Vinegar of opium, 430 

of sanguinaria, 266 

of squill, 637 
Vinegars, 84 
Vinum album, 563 

antimonii, 607 

ferri amarum, 1 86 
citratis, 185 

colchici radicis, 256 
seminis, 257 

ergotae, 479 

ipacacuanhae, 61 1 

opii, 430 

picis, 625 

rubrum, 563 
Virginia snake root, 176 
Vleminck's solution or lotion, 56 
Volatile oil of mustard, 769 

oils, 771 

Wahoo, 70, 680 
Warburg's pills, 113 

tincture, 89, 90 
Warming plaster, 125, 772 
Washed sulphur, 671 
Washes, 1 17 

Weights and measures, 42 
W^hiskey, 59, 562 
White arsenic, 236 



White ash, 86 

hellebore, 583 

lead, 727 

mustard, 768 

oak, 716 

of egg, 773 

pine compound, 66 

wine, 563 
Wild cherry, 86, 175 

ferrated, 86 
Wilkinson's ointment, 122 
Wine of antimony, 607 

of colchicum root, 256 
seed, 257 

of ergot, 479 

of ferric citrate, 185 

of ipecac, 611 

of opium, 430 

of tar, 625 
Wines, 84 
Woorari, 515 

Xanthoxylum, 270 

Yellow iodide of mercury, 226 

jasmine 504 

mercuric oxide, 227 
subsulphate, 228 

mercurous iodide, 226 

wash, 228 
Verba santa, 64 

Zedoary comp., 92 
Zinc, 711, 734 

acetate, 735 

bromide, 530 

chloride, 757, 761 

iodide, 249, 735 

oxide, 735 

phosphide, 208 

sulphate, 735. 757 

sulphocarbolaie, 309 

valerianate, 384 
Zinci acetas, 735 

bromidum, 530 

carbonas prsecipitatus, 735 

chloridum, 761 

iodidum, 249, 1ZZ 

bxidum, 735 

phosphidum, 208 

sulphas, 735 

sulphocarbolas, 309 

valerianas, 384 
Zincum, 734 
Zingiber, 59, 373 






CATALOGUE 

OF THE 



MEDICAL PUBLICATIONS 

OF 

W. B. SAUNDERS, 

No* 925 WALNUT STREET, PHILADELPHIA. 



Arrangfed Alphabetically and Classified under Subjects* 



'T^HE books advertised in this Catalogue as being sold by subscription are usually to be 
obtained from, traveling solicitors, but they will be sent direct from the office of pub- 
lication (charges of shipment prepaid) upon receipt of the prices given* All the other 
books advertised are commonly for sale by booksellers in all parts of the United States ; 
but any book will be sent by the publisher to any address, carriage prepaid, on receipt of 
the published price* 

Money may be sent at the risk of the publisher in either of the following ways : 
A post-office money order, an express money order, a bank check, and in a registered 
letter. Money sent in any other way is at the risk of the sender* 



See pages 30, 3 J, for a List of Contents classified according to subjects* 



LATEST PUBLICATIONS, 



American Text-Book of Genito-Urinary and Skin Diseases* Page 4. 

American Text-Book of Diseases of Children — Rev* Edition* Page 3. 

American Text-Book of Gynecologfy — Revised Edition* See page 4. 

American Year-Book of Medicine and Surg-ery* See page 6. 

Anders^ Practice of Medicine — Revised Edition* See page 6, 

Vierordt's Medical Diagnosis — Fourth (Revised) Edition* See page 28. 

Van Valzah and Nisbet^s Diseases of the Stomach* See page 28* 

Church and Peterson's Nervous and Mental Diseases* See page 9* 

Da Costa's Surgery — Revised and Enlarged Edition* See page 10. 

Saunders' Medical Hand-Atlases* See page 2. 

Saunders' Pocket Formulary — Fifth (Revised) Edition* See page 24. 

Keen's Surgical Complications of Typhoid Fever* See page 15. 

Griffith on The Baby — Revised Edition* See page 12. 

Butler's Materia Medica and Therapeutics — Revised Edition* Page 8. 

Stevens' Practice of Medicine — Fifth (Revised) Edition* See page 27* 

De Schweinitz' Diseases of the Eye — Revised Edition* See page 10. 

Chapin's Compendium of Insanity* See page 8. 

Senn's Genito-Urinary Tuberculosis. See page 25. 

Penrose's Diseases of Women. See page 18. 

McFarland's Pathogenic Bacteria — Revised Edition* See page 17. 

Macdonald's Surgical Diagnosis* See page 16. 

Moore's Orthopedic Surgery* See page 17. 

Mallory and Wright's Pathological Technique* See page 16* 



Saunders' Medical Hand-Atlases. 

The series of books included under this title are authorized translations into English 
of the world-famous 

Lehmann Medicinische Hand=atlanten. 

For scientific accuracy, pictorial beauty, compactness, and cheapness these books 
surpass any similar volumes ever published. Each volume contains from 

50 to 100 Colored Plates, 

besides numerous other illustrations in the text. These colored plates have been executed 
by the most skilful German lithographers, in some cases twenty or more impressions being 
required to obtain the desired result. There is a full and appropriate description of each 
plate (printed, for convenience, opposite the plate) , together with a condensed outline of 
the subject to which the book is devoted. 

The same careful and competent editorial supervision will be secured in the 
English edition as in the originals. . The translations will be directed and edited by the 
leading American specialists in the different subjects. 

The great advantage of natural pictorial representation is indisputable. For lasting and 
practical knowledge, one accurate illustration is better than several pages of dry 
description. 

These Atlases offer a ready and satisfactory substitute for clinical observation, avail- 
able only to the residents of large medical centers ; and with such persons the requisite 
variety is seen only after long years of routine hospital service. 

By reason of their projected universal translation and reproduction, affording inter- 
national distribution, the publishers have been enabled to secure for these Atlases the best 
artistic and professional talent, to produce them in the most elegant style, and yet to 
offer them at a price heretofore unapproached in cheapness. The success of the under- 
taking is demonstrated by the fact that volumes have already appeared in German, English, 
French, Italian, Russian, Spanish, Danish, Swedish, and Hungarian. 

"While appreciating the value of such colored plates, the profession has heretofore been 
practically debarred from purchasing similar works because of their extremely high price, 
made necessary by the limited sale and the enormous expense of production. The very 
low price of these Atlases will place them within the reach of even the novice in practice. 

NOW READY. 

Atlas of Internal Medicine and Clinical Diagnosis. By Dr. Chr. Jakob, of Erlangen. Edited 
b3' Augustus A. Eshner, M.D., Professor of Clinical Medicine in the Philadelphia Polyclinic; At- 
tending Physician to the Philadelphia Hospital. 68 colored plates, and 64 illustrations in the text. 
Cloth, I3.Q0 net. 

Atlas of Legal Medicine. By Dr. E. R. von Hofmann, of Vienna. Edited by Frederick Peter- 
son, M.D., Clinical Professor of Mental Diseases, Woman's Medical College, New York; Chief 
of Clinic, Nervous Dept., College of Physicians and Surgeons, New York. With 120 colored fig- 
ures on 56 plates, and 193 beautiful half-tone illustrations. Cloth, $3.50 net. 

Atlas of Diseases of the Larynx. By Dr. L. Grunwald, of Munich. Edited by Charles P. 
Grayson, M.D., Lecturer on Laryngology and Rhinology in the University of Pennsylvania; 
Physician-in-Charge, Throat and Nose Department, Hospital of the University of Pennsylvania. 
With 107 colored figures on 44 plates, and 25 text-illustrations. Cloth, I2.50 net. 

Atlas of Operativ Surgery. By Dr. O. Zuckkrkandl, of Vienna. Edited by J. Chalmers 
DaCosta, M.D., Clinical Professor of Surgery, Jetterson Medical College, Philadelphia; Surgeon 
to the Philadelphia Hospital. With 24 colored plates, and 217 text illustrations. Cloth, $3.00 net. 

Atlas of Syphilis and the Venereal Diseases. By Prof. Dr. Franz Mracek, of Vienna. Edited 
by L. Bolton Bangs, M.D., late Professor of Genito-Urinary and Venereal Diseases, New York 
Post-Graduate Medical School and Hospital. With 71 colored plates from original water-colors, 
and 16 black-and-white illustrations. Cloth, $3.50 net. 

IN PREPARATION. 

Atlas of External Diseases of the Eye. By Dr. O. Haab, of Zurich. Edited by G. E. 
DE ScHWEiNiTZ, M.D., Professor of Ophthalmology, Jefferson Medical College, Philadelphia. 
With 100 colored illustrations. 

Atlas of Skin Diseases. By Prof. Dr. Franz Mracek, of Vienna. With 80 colored plates from 
original water-colors. 

Atlas of Pathological Histology. Atlas of Operative Gynecology. 

Atlas of Orthopedic Surgery. Atlas of Psychiatry. 

Atlas of General Surgery. Atlas of Diseases of the Ear. 




h 



THE AMERICAN TEXT-BOOK SERIES. 

AN AMERICAN TEXT=BOOK OF APPLIED THERAPEUTICS. 

By 43 Distinguished Practitioners and Teachers. Edited by James C. 
Wilson, M.D., Professor of the Practice of Medicine and of Clinical 
Medicine in the Jefferson Medical College, Philadelphia. One hand- 
some imperial octavo volume of 1326 pages. Illustrated. Cloth, 
^7.00 net; Sheep or Half Morocco, $8.00 net. SoM by Subscription. 

*' As a work either for study or reference it will be of great value to the practitioner, as 
it is virtually an exposition of such clinical therapeutics as experience has taught to be ol 
the most value. Taking it all in all, no recent publication on therapeutics can be compared 
with this one in practical value to the working physician." — Chicago Clinical Revieiv. 

" The whole field of medicine has been well covered. The, work is thoroughly prac- 
tical, and while it is intended for practitioners and students, it is a better book for the general 
practitioner than for the student. The young practitioner especially will find it extremely 
suggestive and helpful." — The Indian Lancet. 

AN AMERICAN TEXT=BOOK OF THE DISEASES OF CHILDREN. 
Second Edition, Revised. 

By 61 Eminent Contributors. Edited by Louis Starr, M.D. , Physi- 
cian to the Children's Hospital, Philadelphia, etc.; assisted by 
Thompson S. Westcott, M.D., Attending Physician to the Dispen- 
sary for Diseases of Children, Hospital of the University of Pennsyl- 
vania. In one handsome imperial octavo volume of 1250 pages, 
profusely illustrated. Cloth, ^7.00 net; Sheep or Half Morocco, 
^8.00 net. Sold by Subscription. 

"This is far and away the best text-book on children's diseases ever published in the 
English language, and is certainly the one which is best adapted to American readers. 
We congratulate the editor upon the result of his work, and heartily commend it to the 
attention of every student and practitioner. ' ' — American Journal of the Medical Sciences. 

AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, 
NOSE, AND THROAT. 

By 58 Prominent Specialists. Edited by G. E. de Schweinitz, M.D., 
Professor of Ophthalmology in the Jefferson Medical College, Phila- 
delphia ; and B. Alexander Randall, M.D., Professor of Diseases 
of the Ear in the University of Pennsylvania and in the Philadelphia 
Polyclinic. Ready soon. 



Illustrated Catalogue of the ** American Text-Books'' sent free upon application. 



4 Medical Publications of W. B. Saunders. 

\N AMERICAN TEXT=BOOK OF GENITO=URINARY AND SKIN 
DISEASES. 

By 47 Eminent Specialists and Teachers. Edited by L. Bolton 
Bangs, M.D., Late Professor of Genito-Urinary and Venereal Diseases, 
New York Post-Graduate Medical School and Hospital ; and W. 
A. Hardaway, M.D., Professor of Diseases of the Skin, Missouri 
Medical College. Imperial octavo volume of 1229 pages, with 300 en- 
gravings and 20 full-page colored plates. Cloth, $j.oo net; Sheep 
or Half Morocco, $8.00 net. Sold by Subscription. 

" This volume is one of the best yet issued of the publisher's series of ' American Text- 
Books.' The list of contributors represents an extraordinary array of talent and extended 
experience. The book will easily take the place in comprehensiveness and value of the 
half dozen or more costly v^'orks on these subjects which have heretofore been necessary to 
a well-equipped library." — Nezo York Polyclinic. 

AN AMERICAN TEXT=BOOK OF GYNECOLOGY, MEDICAL AND 
SURGICAL. Second Edition, Revised. 

By 10 of the Leading Gynecologists of America. Edited by J- M. 
Baldy, M. D., Professor of Gynecology in the Philadelphia Polyclinic, 
etc. Handsome imperial octavo volume of over 700 pages, with 341 
illustrations in the text, and 38 colored and half-tone plates. Cloth^ 
^6.00 net; Sheep or Half Morocco, ^7.00 net. Sold by Subscription. 
" It is practical from beginning to end. Its descriptions of conditions, its recommen- 
dations for treatment, and above all the necessary technique of different operations, are 
clearly and admirably presented. . . . It is well up to the most advanced views of the 
day, and embodies aU the essential points of advanced American gynecology. It is destined 
to make and hold a place in gynecological literature which will be peculiarly its own." — 
Medical Record, New York. 

AN AMERICAN TEXT=BOOK OF LEGAL MEDICINE AND TOXI- 
COLOGY. 

Edited by Frederick Peterson, M.D., Clinical Professor of Mental 
Diseases in the Woman's Medical College, New York; Chief of Clinic, 
Nervous Department, College of Physicians and Surgeons, New York ; 
and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy, 
and Toxicology in Rush Medical College, Chicago. In Preparation. 

AN AMERICAN TEXT=BOOK OF OBSTETRICS. 

By 15 Eminent American Obstetricians. Edited by Richard C. Nor- 
Ris, M.D.; Art Editor, Robert L. Dickinson, M.D, One handsome 
imperial octavo volume of over 1000 pages, with nearly 900 beautiful 
colored and half-tone illustrations. Cloth, $7.00 net; Sheep or Half 
Morocco, ^8.00 net. Sold by Subscription. 

" Permit me to say that your American Text-Book of Obstetrics is the most magnificent 
medical work that I have ever seen. I congratulate you and thank you for this superb work, 
which alone is sufficient to place you first in the ranks of medical publishers. " — Alexander 
J. C. Skene, Professor of Gynecology in the Long Island College Hospital, Brooklyn, N. V. 

" This is the most sumptuously illustrated work on midwifery that has yet appeared. In 
the number, the excellence, and the beauty of production of the illustrations it far surpasses 
every other book upon the subject. This feature alone makes it a work which no medical 
library should omit to purchase." — British Medical Joiirnal. 

"As an authority, as a book of reference, as a ' working book ' for the student or prac- 
titioner, we commend it because we believe there is no better." — American Journal of the 
Medical Sciettces. 

Illustrated Catalogue of the **American Text-Books '' sent free upon application^ 



Medical Publications of W. B. Saunders. 5 

AN AMERICAN TEXT=BOOK OF PATHOLOGY. 

Edited by John Guiteras, M.D., Professor of General Pathology and 
of Morbid Anatomy in the University of Pennsylvania ; and David 
RiESMAN, M.D. , Demonstrator of Pathological Histology in the 
University of Pennsylvania. I?i Prepai'ation. 

AN AMERICAN TEXT=BOOK OF PHYSIOLOGY. 

By I o of the Leading Physiologists of America. Edited by William 
H. Howell, Ph.D., M.D., Professor of Physiology in the Johns Hop- 
kins University, Baltimore, Md. One handsome imperial octavo 
volmiie of 1052 pages. Illustrated. Cloth, $6.00 net; Sheep or Half 
Morocco, ^7.00 net. Sold by Subscription. 

" We can commend it most heartily, not only to all students of physiology, but to every 
physician and pathologist, as a valuable and comprehensive w^ork of reference, written by 
men who are of eminent authority in their own special subjects." — London Lancet. 

" To the practitioner of medicine and to the advanced student this volume constitutes, 
we believe, the best exposition of the present status of the science of physiology in the 
English language." — American Journal of the Medical Sciences. 

AN AMERICAN TEXT=BOOK OF SURGERY. Second Edition. 

By 13 Eminent Professors of Surgery. Edited by William W. Keen, 
M.D., LL.D., and J. William White, M.D., Ph.D. Handsome 
imperial octavo volume of 1250 pages, with 500 wood-cuts in the text, 
and 39 colored and half-tone plates. Thoroughly revised and enlarged, 
with a section devoted to " The Use of the Rontgen Rays in Surgery." 
Cloth, $7.00 net; Sheep or Half Morocco, $8.00 net. Sold by Sub- 
scription. 

" Personally, I should not mind it being called THE Text-Book (instead of A Text- 
Book) , for I know of no single volume which contains so readable and complete an account 
of the science and art of Surgery as this does." — Edmund Owen, F.R.C.S., Member of 
the Board of Examiners of the Royal College of Surgeons, England. 

" If this text-book is a fair reflex of the present position of American surgery, we must 
admit it is of a very high order of merit, and that English surgeons will have to look very 
carefully to their laurels if they are to preserve a position in the van of surgical practice." — 
London Lancet. 

AN AMERICAN TEXT=BOOK OF THE THEORY AND PRACTICE 
OF MEDICINE. 

By 12 Distinguished American Practitioners. Edited by William 
Pepper, M.D., LL.D., Professor of the Theory and Practice of Medi- 
cine and of Clinical Medicine in the University of Pennsylvania. Two 
handsome imperial octavo volumes of about 1000 pages each. Illus- 
trated. Prices per volume : Cloth, $5 . 00 net ; Sheep or Half Morocco, 
^6.00 net. Sold by Subscription. 

" I am quite sure it will commend itself both to practitioners and students of medicine, 
and become one of our most popular text-books." — Alfred Loomis, M.D., LL.D., Pro- 
fessor of Pathology and Practice of Medicine, University of the City of New York. 

" We reviewed the first volume of this work, and said : ' It is undoubtedly one of the 
best text-books on the practice of medicine which we possess.' A consideration of the 
second and last volume leads us to modify that verdict and to say that the completed work 
is in our opinion the best of its kind it has ever been our fortune to see. " — New York Medical 
Journal. 

Illttstrated Catalogue of the ** American Text-Books^' sent free upon application. 



6 Medical Publications of W. B, Saunders, 

AN AMERICAN YEAR-BOOK OF MEDICINE AND SURGERY. 

A Yearly Digest of Scientific Progress and Authoritative Opinion in all 
branches of Medicine and Surgery, drawn from journals, monographs, 
and text-books of the leading American and Foreign authors and 
investigators. Collected and arranged, with critical editorial com- 
ments, by eminent American specialists and teachers, under the general 
editorial charge of George M. Gould, M.D. One handsome imperial 
octavo volume of about 1200 pages. Uniform in style, size, and 
general make-up with the ''American Text-Book" Series. Cloth, 
^6.50 net; Half Morocco, ^7.50 net. Scld by Subscription. 

" It is difficult to know which to admire most — the research and industry of the distin- 
guished band of experts whom Dr. Gould has enlisted in the service of the Year-Book, or the 
wealth and abundance of the contributions to every department of science that have been 
deemed worthy of analysis. . . . It is much more than a mere compilation of abstracts, 
for, as each section is entrusted to experienced and able contributors, the reader has the 
advantage of certain critical commentaries and expositions . . . proceeding from writers 
fully qualified to perform these tasks. . . . It is emphatically a book which should find 
a place in every medical library, and is in several respects more useful than the famous 
' Jahrbiicher' of Germany." — London Lancet. 

ANDERS' PRACTICE OF MEDICINE. Second Edition. 

AText=Book of the Practice of Medicine. By James M. Anders, 
M.D., Ph.D., LL.D., Professor of the Practice of Medicine and of 
Clinical Medicine, Medico- Chirurgical College, Philadelphia. In one 
handsome octavo volume of 1287 pages, fully illustrated. Cloth, 
^5.50 net; Sheep or Half Morocco, ^6.50 net. 

" It is an excellent book, — concise, comprehensive, thorough, and up to date. It is a 
credit to you ; but, more than that, it is a credit to the profession of Philadelphia — to us." 
James C. Wilson, Professor of the Practice of Medicine and Clinical Medicine, Jefferson 
Medical College, Philadelphia. 

" 1 consider Dr. Anders' book not only the best late work on Medical Practice, but by 
far the best that has ever been published. It is concise, systematic, thorough, and fully up 
to date in everything. I consider it a great credit to both the author and the publisher." — 
A. C. COWPERTHWAITE, President of the Lllinois Homeopathic Medical Association. 

ASHTON'S OBSTETRICS. Fourth Edition, Revised. 

•Essentials of Obstetrics. By W. Easterly Ashton, M.D., Pro- 
fessor of Gynecology in the Medico-Chirurgical College, Philadelphia. 
Crown octavo, 252 pages; 75 illustrations. Cloth, ^i. 00; interleaved 
for notes, ^1.25. 

[See Saunders'' Question- Compends, page 21.] 

" Embodies the whole subject in a nut-shell. We cordially recommend it to our read 
ers." — Chicago Medical Tivies. 

BALL'S BACTERIOLOGY. Third Edition, Revised. 

Essentials of Bacteriology ; a Concise and Systematic Introduction 
to the Study of Micro-organisms. By M. V. Ball, M.D., Bacteriol- 
ogist to St. Agnes' Hospital, Philadelphia, etc. Crown octavo, 218 
pages; 82 illustrations, some in colors, and 5 plates. Cloth, ^i.oo; 
interleaved for notes, ^1.25. 

[See Saunders Question- Compends, page 21.] 

' ' The student or practitioner can readily obtain a knowledge of the subject from a perusal 
of this book. The illustrations are clear and satisfactory." — Medical Record, New York. 



Medical Publications of W. B, Saunders, 7 

BASTIN'S BOTANY. 

Laboratory Exercises in Botany. By Edson S. Bastin, M.A., 
late Professor of Materia Medica and Botany, Philadelphia College of 
Pharmacy. Octavo volume of 536 pages, with 87 plates. Cloth, 32. 50. 

"It is unquestionably the best text-book on the subject that has yet appeared. The 
work is eminently a practical one. We regard the issuance of this book as an important 
event in the history of pharmaceutical teaching in this country, and predict for it an unquali- 
fied success." — A/umm Report to the Philadelphia College of Pharmacy. 

''There is no work like it in the pharmaceutical or botanical literature of this country, 
and we predict for it a wide circulation." — Americaji Journal of Pharmacy. 

BECK'S SURGICAL ASEPSIS. 

A Manual of Surgical Asepsis. By Carl Beck, M.D., Surgeon to 
St. Mark's Hospital and the New York German Poliklinik, etc. 306 
pages; 6^ text-illustrations, and 12 full- page plates. Cloth, $1.25 net. 

"An excellent exposition of the 'very latest' in the treatment of wounds as practised 
by leading German and American surgeons." — Bir??iinghai?i (Eng.) Medical Review. 

"This little volume can be recommended to any who are desirous of learning the details 
of asepsis in surger}', for it will serve as a trustworthy guide." — London Lancet. 

BOISLINIERE'S OBSTETRIC ACCIDENTS, EMERGENCIES, AND 
OPERATIONS. 
Obstetric Accidents, Emergencies, and Operations. By L. Ch. 

BoisLiNiERE, M.D., late Emeritus Professor of Obstetrics, St. Louis 
Medical College. 381 pages, handsomely illustrated. Cloth, ^2.00 net. 

" It is clearly and concisely written, and is evidently the work of a teacher and practi- 
tioner of large experience." — British Medical Journal. 

" A manual so useful to the student or the general practitioner has not been brought to 
our notice in a long time. The field embraced in the title is covered in a terse, interesting 
way." — Yale Medical Journal. 

BROCKWAY'S MEDICAL PHYSICS. Second Edition, Revised. 
Essentials of Medical Physics. By Fred J. Brockway, M.D., 
Assistant Demonstrator of Anatomy in the College of Physicians and 
Surgeons, New York. Crown octavo, 330 pages; 155 fine illustrations. 
Cloth, ^i.oo net ; interleaved for notes, $1.25 net. 

[See Saunders'' Question- Comp ends, page 21.] 

" The student who is well versed in these pages will certainly prove qualified to com- 
prehend with ease and pleasure the great majority of questions involving physical principles 
likely to be met with in his medical studies." — Ajiierican Practitioner and N'ews. 

"We know of no manual that affords the medical student a better or more concise 
exposition of physics, and the book may be commended as a most satisfactory presentation 
of those essentials that are requisite in a course in medicine." — Nexv York Medical Journal. 

" It contains all that one need know on the subject, is well written, and is copiously 
illustrated." — Medical Record, New York. 

BURR ON NERVOUS DISEASES. 

A Manual of Nervous Diseases. By Charles W. Burr, M.D., 
Clinical Professor of Nervous Diseases, Medico-Chirurgical College, 
Philadelphia ; Pathologist to the Orthopedic Hospital and Infirmary 
for Nervous Diseases; Visiting Physician to St. Joseph's Hospital, etc. 
In Preparation. 



8 Medical Publications of W. B. Saunders. 

BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR= 
MACOLOQY. Second Edition, Revised. 
A Text=Book of Materia Medica, Therapeutics, and Pharma= 
cology. By George F. Butler, Ph.G., M.D., Professor of Materia 
Medica and of Clinical Medicine in the College of Physicians and 
Surgeons, Chicago; Professor of Materia Medica and Therapeutics, 
Northwestern University, Woman's Medical School, etc. Octavo, 860 
pages, illustrated. Cloth, ^4.00 net; Sheep, ^5.00 net. 

" Taken as a whole, the book may fairly be considered as one of the most satisfactory 
of any single-volume works on materia medica in the market," — Journal of the American 
Medical Association. 

"The work is executed in a clear, concise, and practical manner, and should meet with 
a hearty endorsement from the students of our up-to-date colleges. The book will be found 
a valuable work of reference for the practitioner." — American Medico-Surgical Bulletin. 

CASSELBERRY ON THE NOSE AND THROAT. 

Diseases of the Nose and Throat. By W. E. Casselberry, Pro- 
fessor of Laryngology and Rhinology in the Northwestern University 
Medical School, Chicago. In Frepa7'ation. 

CERNA ON THE NEWER REMEDIES. Second Edition, Revised. 
Notes on the Newer Remedies, their Therapeutic Applications 
and Modes of Administration. By David Cerna, M.D., Ph.D., 
formerly Demonstrator of and Lecturer on Experimental Therapeutics 
in the University of Pennsylvania ; Demonstrator of Physiology in the 
Medical Department of the University of Texas. Rewritten and 
greatly enlarged. Post-octavo, 253 pages. Cloth, $1.25. 

" The appearance of this new edition of Dr. Cerna's very valuable work shows that it 
is properly appreciated. The book ought to be in the possession of every practising physi- 
cian." — New York Medical Journal. 

CHAPIN ON INSANITY. 

A Compendium of Insanity. By John B. Chapin, M.D., LL.D., 

Physician-in-Chief, Pennsylvania Hospital for the Insane ; late Physi- 
cian-Superintendent of the Willard State Hospital, New York ; Hon- 
orary Member of the Medico-Psychological Society of Great Britain, 
of the Society of Mental Medicine of Belgium. i2mo, 234 pages, 
illustrated. Cloth, ^1.25 net. 

The author has given, in a condensed and concise form, a compendium of Diseases of 
the Mind, for the convenient use and aid of physicians and students. The work will also 
prove valuable to members of the legal profession and to those who, in their relations to the 
insane and to those supposed to be insane, often desire to acquire some practical knowledge 
of insanity presented in a form that may be understood by the non-professional reader. 

CHAPMAN'S MEDICAL JURISPRUDENCE AND TOXICOLOGY. 
Second Edition, Revised. 
Medical Jurisprudence and Toxicology. By Henry C. Chapman, 
M.D., Professor of Institutes of Medicine and Medical Jurisprudence 
in the Jefferson Medical College of Philadelphia. 254 pages, with 55 
illustrations and 3 full-page plates in colors. Cloth, ^1.50 net. 

"The best book of its class for the undergraduate that we know of." — New York 
Medical Times. 



Medical Publications of W. B. Saunders, 9 

CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES. 
Nervous and Mental Diseases. By Archibald Church, M.D., 
Professor of Mental Diseases and Medical Jurisprudence in the North- 
western University Medical School, Chicago ; and Frederick Peter- 
son, M.D., Clinical Professor of Mental Diseases in the Woman's 
Medical College, New York ; Chief of Clinic, Nervous Department, 
College of Physicians and Surgeons, New York. In Preparatio7i. 

CLARKSON'S HISTOLOGY. 

A Text=Book of Histology, Descriptive and Practical. By 

Arthur Clarkson, M.B., CM. Edin., formerly Demonstrator of 
Physiology in the Owen's College, Manchester; late Demonstrator of 
Physiology in Yorkshire College, Leeds. Large octavo, 554 pages; 
22 engravings in the text, and 174 beautifully colored original illustra- 
tions. Cloth, strongly bound, ^6.00 net. 

" The work must be considered a valuable addition to the list of available text- books, 
and is to be highly recommended." — N'ew York Aledical Journal. 

"This is one of the best works for students we have ever noticed. We predict that the 
book will attain a well-deserved popularity among our students." — Chicago Medical Recorder. 

"The volume is a most valuable addition to the armamentarium of the teacher." — 
Brooklyn Medical Journal. 

CLIMATOLOGY. 

Transactions of the Eighth Annual Meeting of the American 
Climatological Association, held in Washington, September 22-25, 
1 89 1. Forming a handsome octavo volume of 276 pages, uniform with 
remainder of series. (A limited quantity only.) Cloth, ^1.50. 

COHEN AND ESHNER'S DIAGNOSIS. 

Essentials of Diagnosis. By Solomon Solis-Cohen, M.D., Pro- 
fessor of Clinical Medicine and Applied Therapeutics in the Philadel- 
phia Polyclinic ; and Augustus A. Eshner, M.D. , Professor of Clinical 
Medicine in the Philadelphia Polyclinic. Post-octavo, 382 pages; 55 
illustrations. Cloth, ^1.50 net. 

[See Smmders^ Question- Co7?ipends, page 21.] 

"We can heartily commend the book to all those who contemplate purchasing a 'com- 
pend.' It is modern and complete, and will give more satisfaction than many other works 
which are perhaps too prolix as well as behind the times." — Medical Review, St. Louis. 

CORWIN'S PHYSICAL DIAGNOSIS. 

Essentials of Physical Diagnosis of the Thorax. By Arthur 
M. CoRwiN, A.M., M.D., Demonstrator of Physical Diagnosis in Rush 
Medical College, Chicago ; Attending Physician to Central Free Dis- 
pensary, Department of Rhinology, Laryngology, and Diseases of the 
Chest, Chicago. 200 pages, illustrated. Cloth, flexible covers, ^1.25 net. 

" It is excellent. The student who shall use it as his guide to the careful study of 
physical exploration upon normal and abnormal subjects can scarcely fail to acquire a good 
working knowledge of the subject." — Philadelphia Polyclinic. 

"A most excellent little work. It brightens the memory of the differential diagnostic 
signs, and it arranges orderly and in sequence the various objective phenomena to logical 
solution of a careful diagnosis." — Journal of Nervous and Mental Diseases. 



10 Medical Publications of W. B. Saunders, 

CRAQIN'S GYNECOLOGY. Fourth Edition, Revised. 

Essentials of Gynaecology. By Edwin B. Cragin, M.D., Attend- 
ing Gynaecologist, Roosevelt Hospital, Out-Patients' Department, New 
York, etc. Crown octavo, 200 pages; 62 fine illustrations. Cloth,, 
^i.oo; interleaved for notes, ^1.25. 

[See Saunders'' Questioii- Coinpends , page 21.] 

" A handy volume, and a distinct improvement on students' compends in general. No 
author who was not himself a practical gynecologist could have consulted the student's needs 
so thoroughly as Dr. Cragin has done." — Medical Record, New York. 

CROOKSHANK'S BACTERIOLOGY. Fourth Edition, Revised. 

A Text=Book of Bacteriology. By Edgar M. Crookshank, M.B.^ 
Professor of Comparative Pathology and Bacteriology, King's College, 
London. Octavo volume of 700 pages, with 273 engravings and 22 
original colored plates. Cloth, ^6.50 net; Half Morocco, ^7.50 net. 

" To the student who wishes to obtain a good resume of what has been done in bacteri- 
ology, or who wishes an accurate account of the various methods of research, the book may 
be recommended with confidence that he will find there what he requires." — London Lancet. 

Da COSTA'S SURGERY. Second Ed., Revised and Greatly Enlarged. 
Modern Surgery, General and Operative. By John Chalmers 
DaCosta, M.D., Clinical Professor of Surgery, Jefferson Medical 
College, Philadelphia ; Surgeon to the Philadelphia Hospital, etc. 
Handsome octavo volume of 900 pages, profusely illustrated. Cloth, 
$4.00 net; Half Morocco, ^5.00 net. 

"We know of no small work on surgery in the English language which so well fulfils 
the requirements of the modern student." — Medico-Chirurgical Jotirnal, Bristol, England. 

DE SCHWEINITZ ON DISEASES OF THE EYE. Third Edition, 
Revised. 
Diseases of the Eye, A Handbook of Ophthalmic Practice. 

By G. E. DE ScHWEiNiTZ, M.D., Professor of Ophthalmology in the 
Jefferson Medical College, Philadelphia, etc. Handsome royal octavo 
volume of 700 pages, with 256 fine illustrations and 2 chromo-litho- 
graphic plates. Cloth, ^4.00 net ; Sheep or Half Morocco, ^5.00 net. 

" A clearly written, comprehensive manual. One which we can commend to students 
as a reliable text-book, written with an evident knowledge of the wants of those entering 
upon the study of this special branch of medical science." — British Medical Journal. 

"A work that will meet the requirements not only of the specialist, but of the general 
practitioner in a rare degree. I am satisfied that unusual success awaits it." — William 
Pepper, M.D., Professor of the Theory and Practice of Medicine and Clinical Medicine, 
University of Pennsylvania. 

DORLAND'S OBSTETRICS. 

A Manual of Obstetrics. By W. A. Newman Borland, M.D., 
Assistant Demonstrator of Obstetrics, University of Pennsylvania; 
Instructor in Gynecology in the Philadelphia Polyclinic. 760 pages; 
163 illustrations in the text, and 6 full-page plates. Cloth, ^2.50 net. 

" By far the best book on this subject that has ever come to our notice." — American 
Medical Review. 

" It has rarely been our duty to review a book which has given us more pleasure in its 
perusal and more satisfaction in its criticism. It is a veritable encyclopedia of knowledge, 
a gold mine of practical, concise thoughts." — Americajt Medico- Surgical Bulletin. 



Medical Publications of W, B. Saunders. 11 

FROTHINGHAM'S GUIDE FOR THE BACTERIOLOGIST. 

Laboratory Guide for the Bacteriologist. By Langdon Froth- 
INGHAM, M.D.V., Assistant in Bacteriology and Veterinary Science, 
Sheffield Scientific School, Yale University. Illustrated. Cloth, 75 cts. 

*' It is a convenient and useful little work, and will more than repay the outlay neces- 
sary for its purchase in the saving of time which would otherwise be consumed in looking 
up the various points of technique so clearly and concisely laid down in its pages." — Ameri- 
can Medico- Surgical Bulletin. 

GARRIGUES' DISEASES OF WOMEN. Second Edition, Revised. 
Diseases of Women. By Henry J. Garrigues, A.M., M.D., Pro- 
fessor of Gynecology in the New York School of Clinical Medicine ; 
Gynecologist to St. Mark's Hospital and to the German Dispensary, 
New York City, etc. Handsome octavo volume of 728 pages, illus- 
trated by 335 engravings and colored plates. Cloth, $4.00 net; 
Sheep or Half Morocco, ^5.00 net. 

" One of the best text-books for students and practitioners which has been published in 
the English language ; it is condensed, clear, and comprehensive. The pi-ofound learning 
and great clinical experience of the distinguished author find expression in this book in a 
most attractive and instructive form. Young practitioners to whom experienced consultants 
may not be available will find in this book invaluable counsel and help." — Thad. A. 
Reamy, M.D., LL.D., Professor of Clinical Gynecology, Medical College of Ohio. 

GLEASON'S DISEASES OF THE EAR. Second Edition, Revised. 
Essentials of Diseases of the Ear. By E. B. Gleason, SB., 
M.D., Clinical Professor of Otology, Medico-Chirurgical College, 
Philadelphia ; Surgeon-in-Charge of the Nose, Throat, and Ear Depart- 
ment of the Northern Dispensary, Philadelphia. 208 pages, with 
114 illustrations. Cloth, $1.00; interleaved for notes, ^1.25. 
[See Saimders' Question- Compends, page 21.] 

" It is just the book to put into the hands of a student, and cannot fail to give him a 
useful introduction to ear-affections ; while the style of question and answer which is adopted 
throughout the book is, we believe, the best method of impressing facts permanently on the 
mind. " — Liverpool Medico- Chirurgical foiirnal. 

GOULD AND PYLE'S CURIOSITIES OF MEDICINE. 

Anomalies and Curiosities of Medicine. By George M. Gould, 
M.D., and Walter L. Pyle, M.D. An encyclopedic collection of 
rare and extraordinary cases and of the most striking instances of 
abnormality in all branches of Medicine and Surgery, derived from an 
exhaustive research of medical literature from its origin to the present 
day, abstracted, classified, annotated, and indexed. Handsome im- 
perial octavo volume of 968 pages, with 295 engravings in the text, 
and 12 full-page plates. Cloth, ^6.00 net; Half Morocco, ^7.00 net. 
Sold by Subscription. 

" One of the most valuable contributions ever made to medical literature. It is, so far 
as we know, absolutely unique, and every page is as fascinating as a novel. Not alone for 
the medical profession has this volume value : it will serve as a book of reference for all who 
are interested in general scientific, sociologic, or medico-legal topics." — Brooklyn Medical 
Journal. 

''This is certainly a most remarkable and interesting volume. It stands alone among 
medical literature, an anomaly on anomalies, in that there is nothing like it elsewhere in 
medical literature. It is a book full of revelations from its first to its last page, and cannot 
but interest and sometimes almost horrify its readers." — American Medico- Surgical Btdletin. 



12 Medical Publications of W, B. Saunders. 

GRIFFIN'S MATERIA MEDICA AND THERAPEUTICS. 

Manual of Materia Medica and Therapeutics. By Henry A. 
Griffin, A.B., M.D., Assistant Physician to the Roosevelt Hospital, 
Out-Patient Department, New York City. In Preparation. 

GRIFFITH ON THE BABY. Second Edition, Revised. 

The Care of the Baby. By J. P. Crozer Griffith, M.D., Clini- 
cal Professor of Diseases of Children, University of Pennsylvania ; 
Physician to the Children's Hospital, Philadelphia, etc. i2mo, 404 
pages, with 67 illustrations in the text, and 5 plates. Cloth, ^1.50. 

" The best book for the use of the young mother with which we are acquainted. . . . 
There are very few general practitioners who could not read the boolc through with advan- 
tage. ' ' — Archives of Pediatrics. 

"The whole book is characterized by rare good sense, and is evidently written by a 
master hand. It can be read with benefit not only by mothers but by medical students and 
by any practitioners who have not had large opportunities for observing children." — Ameri- 
can Journal of Obstetrics. 

GRIFFITH'S WEIGHT CHART. 

Infant's Weight Chart. Designed by J. P. Crozer Griffith, M.D., 
Clinical Professor of Diseases of Children in the University of Penn- 
sylvania, etc. 25 charts in each pad. Per pad, 50 cents net. 

A convenient blank for keeping a record of the child's weight during the first two years 
of life. Printed on each chart is a curve representing the average weight of a healthy infant, 
so that any deviation from the normal can readily be detected. 

GROSS, SAMUEL D., AUTOBIOGRAPHY OF. 

Autobiography of Samuel D. Gross, M.D., Emeritus Professor of 
Surgery in the Jefferson Medical College, Philadelphia, with Remi- 
niscences of His Times and Contemporaries. Edited by his Sons, 
Samuel W. Gross, M.D., LL.D., late Professor of Principles of Sur- 
gery and of Clinical Surgery in the Jefferson Medical College, and 
A. Haller Gross, A.M., of the Philadelphia Bar. Preceded by a 
Memoir of Dr. Gross, by the late Austin Flint, M.D., LL.D. In 
two handsome volumes, each containing over 400 pages, demy octavo, 
extra cloth, gilt tops, with fine Frontispiece engraved on steel. Price 
per volume, ^2.50 net. 

*' Dr. Gross was perhaps the most eminent exponent of medical science that America 
has yet produced. His Autobiography, related as it is with a fulness and completeness 
seldom to he found in such works, is an interesting and valuable book. He comments on 
many things, especially, of course, on medical men and medical practice, in a very interest- 
ing way." — The Spectator, London, England. 

HAMPTON'S NURSING. 

Nursing: Its Principles and Practice. By Isabel Adams Hamp- 
ton, Graduate of the New York Training School for Nurses attached 
to Bellevue Hospital ; Superintendent of Nurses, and Principal of the 
Training School for Nurses, Johns Hopkins Hospital, Baltimore, Md. 
i2mo, 484 pages, profusely illustrated. Cloth, $2.00 net. 

" Seldom have we perused a book upon the subject that has given us so much pleasure 
as the one before us. We would strongly urge upon the members of our own profession the 
need of a book like this, for it will enable each of us to become a training school in him- 
self. ' ' — Ontario Medical Journal. 



Medical Publications of W. B. Saunders. 13 

HARE'S PHYSIOLOGY. Third Edition, Revised. 

Essentials of Physiology. By H. A. Hare, M.D., Professor of 
Therapeutics and Materia Medica in the Jefferson Medical College of 
Philadelphia; Physician to the Jefferson Medical College Hospital. 
Containing a series of handsome illustrations from the celebrated 
''Icones Nervorum Capitis" of Arnold. Crown octavo, 239 pages. 
Cloth, Si- 00 net; interleaved for notes, $1.25 net. 

[See Saimders' Question- Compends, page 21.] 

" The best condensation of physiological knowledge we have yet seen." — Aledicai 
Record, New York. 

HART'S DIET IN SICKNESS AND IN HEALTH. 

Diet in Sickness and in Health. By Mrs. Ernest Hart, formerly 
Student of the Faculty of Medicine of Paris and of the London School 
of Medicine for Women ; with an Introduction by Sir Henry 
Thompson, F.R.C.S., M.D., London. 220 pages; illustrated. Cloth, 

" We recommend it cordially to the attention of all practitioners ; both to them and to 
their patients it may be of the greatest service." — Xeiu York Medical Journal. 

HAYNES' ANATOz^lY. 

A Manual of Anatomy. By Irving S. Haynes, M.D., Adjunct 
Professor of Anatomy and Demonstrator of Anatomy, Medical Depart- 
ment of the New York University, etc. 680 pages, illustrated with 42 
diagrams in the text, and 134 full-page half-tone illustrations from 
original photographs of the author's dissections. Cloth, $2.50 net. 

" This book is the work of a practical instructor — one who knows by experience the 
requirements of the average student, and is able to meet these requirements in a very satis- 
factory way. The book is one that can be commended." — Medical Record, New York. 

HEISLER'S EMBRYOLOGY. 

A Text=Book of Embryology. By John C. Heisler, M.D., Pro- 
fessor of Anatomy in the Medico-Chirurgical College, Philadelphia. 
In Preparation. 

HIRST'S OBSTETRICS. 

A Text=Book of Obstetrics. By Barton Cooke Hirst, M.D., 
Professor of Obstetrics in the University of Pennsylvania. In Prepa- 
ration. 

HYDE AND MONTGOMERY ON SYPHILIS AND THE VENEREAL 
DISEASES. 
Syphilis and the Venereal Diseases. By James Nevins Hyde, 
M.D., Professor of Skin and Venereal Diseases, and Frank H. Mont- 
gomery, M.D., Lecturer on Dermatology and Genito-Urinary Diseases 
in Rush Medical College, Chicago, 111. 618 pages, profusely illustrated. 
Cloth, $2.50 net. 

" We can commend this manual to the student as a help to him in his study of venereal 
diseases. ' ' — Liverpool Medico- Clm'tD'gical Journal. 

"The best student's manual which has appeared on the subject." — St. Louis Medical 
and Surgical Journal. 



14 Medical Publications of W, B, Saunders, 

JACKSON AND GLEASON'S DISEASES OF THE EYE, NOSE, AND 
THROAT. Second Edition, Revised. 
Essentials of Refraction and Diseases of the Eye. By Edward 
Jackson, A.M., M.D., Professor of Diseases of the Eye in the Phila- 
delphia Polyclinic and College for Graduates in Medicine ; and — 
Essentials of Diseases of the Nose and Throat. By E. Bald- 
win Gleason, M.D., Surgeon-in-Charge of the Nose, Throat, and 
Ear Department of the Northern Dispensary of Philadelphia. Two 
volumes in one. Crown octavo, 290 pages; 124 illustrations. Cloth, 
^i.oo; interleaved for notes, ^1.25. 

[See Saunders' Qii,esiion-Compends, page 21.] 

" Of great value to the beginner in these branches. The authors are both capable men, 
and know what a student most needs." — Medical Record, New York. 

KEATING'S DICTIONARY. Second Edition, Revised. 

A New Pronouncing Dictionary of Medicine, with Phonetic 
Pronunciation, Accentuation, Etymology, etc. By John M. 
Keating, M.D., LL.D., Fellow of the College of Physicians of Phila- 
delphia ; Vice-President of the American Pgediatric Society ; Editor 
''Cyclopaedia of the Diseases of Children," etc.; and Henry 
Hamilton, Author of *-'A New Translation of Virgil's JEneid into 
English Rhyme," etc.; with the collaboration of J. Chalmers Da- 
Costa, M.D., and Frederick A. Packard, M.D. With an Appendix 
containing Tables of Bacilli, Micrococci, Leucomaines, Ptomaines; 
Drugs and Materials used in Antiseptic Surgery; Poisons and their 
Antidotes; Weights and Measures; Thermometric Scales; New 
Official and Unofficial Drugs, etc. One volume of over 800 pages. 
Prices, with Denison's Patent Ready-Reference Index: Cloth, $5.00 
net; Sheep or Half Morocco, $6.00 net; Half Russia, ^6.50 net. 
Without Patent Index: Cloth, ^4.00 net; Sheep or Half Morocco, 
^5.00 net. 

" I am much pleased with Keating's Dictionary, and shall take pleasure in recommend- 
ing it to my classes." — Henry M. Lyman, M.D., Professor of the Principles and Practice 
of Medicine, Rush Medical College, Chicago, III. 

" I am convinced that it will be a very valuable adjunct to my study-table, convenient 
in size and sufficiently full for ordinary use." — C. A. Lindsley, M.D., Professor of the 
Theory and Practice of Medicine, Medical Dept. Yale University. 

KEATING'S LIFE INSURANCE. 

How to Examine for Life Insurance. By John M. Keating, 
M.D., Fellow of the College of Physicians of Philadelphia; Vice- 
President of the American Paediatric Society ; Ex-President of the 
Association of Life Insurance Medical Directors. Royal octavo, 211 
pages ; with two large half-tone illustrations, and a plate prepared by 
Dr. McClellan from special dissections ; also, numerous other illustra- 
tions. Cloth, ^2.00 net. 

" This is by far the most useful book which has yet appeared on insurance examination, 
a subject of growing interest and importance. Not the least valuable portion of the volume 
is Part II, which consists of instructions issued to their examining physicians by twenty-four 
representative companies of this country. If for these alone, the book should be at the right 
hand of every physician interested in this special branch of medical science." — The Medical 
News. 



Medical Publications of W. B. Saunders, 15 

KEEN ON THE SURGERY OF TYPHOID FEVER. 

The Surgical Complications and Sequels of Typhoid Fever. 

By Wm. W. Keen, M.D., LL.D., Professor of the Principles of Sur- 
gery and of Clinical Surgery, Jefferson Medical College, Philadelphia; 
Corresponding Member of the Societe de Chirurgie, Paris ; Honorary 
Member of the Societe Beige de Chirurgie, etc. Octavo volume of 
386 pages, illustrated. Cloth, $3.00 net. 

This monograph is the only one in any language covering the entire subject of the 
Surgical Complications and Sequels of Typhoid Fever. It will prove to be of importance 
and interest not only to the general surgeon and physician, but also to many specialists — laryn- 
gologists, gynecologists, pathologists, and bacteriologists. 

KEEN'S OPERATION BLANK. Second Edition, Revised Form. 
An Operation Blank, with Lists of Instruments, etc. Required 
in Various Operations. Prepared by W. W. Keen, M.D., LL.D., 
Professor of the Principles of Surgery in Jefferson l^Iedical College, 
Philadelphia. Price per pad, containing blanks for fifty operations, 
50 cents net. 

KYLE ON THE NOSE AND THROAT. 

Diseases of the Nose and Throat. By D. Braden Kyle, M.D., 
Clinical Professor of Laryngology and Rhinology, Jefferson Medical 
College, Philadelphia; Consulting Laryngologist, Rhinologist, and 
Otologist, St. Agnes' Hospital ; Bacteriologist to the Philadelphia 
Orthopedic Hospital. In Preparation. 

LAINE'S TEMPERATURE CHART. 

Temperature Chart. Prepared by D. T. Laine, M.D. Size 8x131^ 
inches. A conveniently arranged Chart for recording Temperature, 
with columns for daily amounts of Urinary and Fecal Excretions, 
Food, Remarks, etc. On the back of each chart is given in full the 
method of Brand in the treatment of Typhoid Fever. Price, per pad 
of 25 charts, 50 cents net. 

" To the busy practitioner this chart will be found of great value in fever cases, and 
•especially for cases of typhoid." — Indian Lancet, Calcutta. 

LOCKWOOD'S PRACTICE OF MEDICINE. 

A Manual of the Practice of Medicine. By George Roe Lock- 
WOOD, M.D., Professor of Practice in the Woman's Medical College 
of the New York Infirmary, etc. 935 pages, with 75 illustrations in 
the text, and 22 full-page plates. Cloth, ^2.50 net. 

" Gives in a most concise manner the points essential to treatment usually enumerated 
in the most elaborate works." — Massachusetts Medical Jour^ial. 

LONG'S SYLLABUS OF GYNECOLOGY. 

A Syllabus of Gynecology, arranged in Conformity with ♦* An 
American Text=Book of Gynecology." By J. W. Long, M.D., 
Professor of Diseases of Women and Children, Medical College of 
Virginia, etc. Cloth, interleaved, $1.00 net. 

" The book is certainly an admirable resume of what every gynecological student and 
practitioner should know, and Avill prove of value not only to those who have the ' American 
Text-Book of Gynecology,' but to others as well." — Brooklyn Medical Journal. 



16 Medical Publications of W. B, Saunders, 

MACDONALD*S SURGICAL DIAGNOSIS \ND TREATMENT. 

Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. 
Edin., L.R.C.S., Edin., Professor of the Practice of Surgery and of 
Clinical Surgery in Hamline University ; Visiting Surgeon to St. 
Barnabas' Hospital, Minneapolis, etc. Handsome octavo volume of 
800 pages, profusely illustrated. Cloth, ^5.00 net; Half Morocco^ 
$6.00 net. 

*' A thorough and complete work on surgical diagnosis and treatment, free from pad- 
ding, full of valuable material, and in accord with the surgical teaching of the day." — T/ie 
Medical Nezvs, New York. 

"The work is brimful of just the kind of practical information that is useful alike to 
students and practitioners. It is a pleasure to commend the book because of its intrinsic 
value to the medical practitioner." — Cincinnati Lancet- Clinic. 

MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE. 

Pathological Technique. A Practical Manual for Laboratory Work 
in Pathology, Bacteriology, and Morbid Anatomy, with chapters on 
Post-Mortem Technique and the Performance of Autopsies. By Frank 
B. Mallory, A.m., M.D., Assistant Professor of Pathology, Harvard 
University Medical School, Boston; and James H. Wright, A.M., 
M.D., Instructor in Pathology, Harvard University Medical School, 
Boston. Octavo volume of 396 pages, handsomely illustrated. Cloth, 
$2.50 net. 

" I have been looking forward to the publication of this book, and I am glad to say that 
I find it to be a most useful laboratory and post-mortem guide, full of practical information, 
and well up to date." — William H." Welch, Professor of Pathology, Johns Hopkins Uni- 
versity, Baltimore, Md. 

MARTIN'S MINOR SURGERY, BANDAGING, AND VENEREAL 
DISEASES. Second Edition, Revised. 
Essentials of Minor Surgery, Bandaging, and Venereal 
Diseases. By Edward Martin, A.M., M.D., CHnical Professor of 
Genito-Urinary Diseases, University of Pennsylvania, etc. Crown 
octavo, 166 pages, with 78 illustrations. Cloth, ^i.oo; interleaved for 
notes, ^1.25. 

[See Saunders^ Question- Compends, page 21.] 

"A very practical and systematic study of the subjects, and shows the author's famil- 
iarity with the needs of students." — Therapeutic Gazette. 

MARTIN'S SURGERY. Sixth Edition, Revised. 

Essentials of Surgery. Containing also Venereal Diseases, Surgi- 
cal Landmarks, Minor and Operative Surgery, and a complete de- 
scription, with illustrations, of the Handkerchief and Roller Bandages. 
By Edward Martin, A.M., M.D., Clinical Professor of Genito- 
Urinary Diseases, University of Pennsylvania, etc. Crown octavo, 338 
pages, illustrated. With an Appendix containing full directions for the 
preparation of the materials used in Antiseptic Surgery, etc. Cloth, 
;^i.oo; interleaved for notes, $1.25. 

[See Saunders' Question- Compends, page 21.] 

** Contains all necessary essentials of modern surgery in a comparatively small space. 
Its style is interesting, and its illustrations are admirable." — Medical and Surgical Reporter, 



Medical Publications of W, B. Saunders, 17 

/VlcFARLAND'S PATHOGENIC BACTERIA. Second Edition, Re- 
vised and Greatly Enlarged. 
Text=Book upon the Pathogenic Bacteria. By Joseph McFar- 
LAND, M. D. , Professor of Pathology and Bacteriology in the Medico- 
Chirurgical College of Philadelphia, etc. Octavo volume of 497 pages, 
finely illustrated. Cloth, ^2.50 net. 

" Dr. McFarland has treated the subject in a systematic manner, and has succeeded in 
presenting in a concise and readable form the essentials of bacteriology up to date. Alto- 
gether, the book is a satisfactory one, and I shall take pleasure in recommending it to the 
students of Trinity College."— H. B. Anderson, M.D. , Professor of Pathology and Bac- 
teriology, Trinity Medical College, Toronto. 

MEIGS ON FEEDING IN INFANCY. 

Feeding in Early Infancy. By Arthur V. Meigs, M.D. Bound 
in limp cloth, flush edges, 25 cents net. 

" This pamphlet is worth many times over its price to the physician. The author's 
experiments and conclusions are original, and have been the means of doing much good." — 
Medical Bulletin. 

MOORE'S ORTHOPEDIC SURGERY. 

A Manual of Orthopedic Surgery. By James E. Moore, M.D., 
Professor of Orthopedics and Adjunct Professor of Clinical Surgery, 
University of Minnesota, College of Medicine and Surgery. Octavo 
volume of 356 pages, handsomely illustrated. Cloth, ^2.50 net. 

A practical book based upon the author's experience, in which special stress is laid 
upon early diagnosis, and treatment such as can be carried out by the general practitioner. 
The teachings of the author are in accordance with his belief that true conservatism is to 
be found in the middle course between the surgeon who operates too frequently and the 
orthopedist who seldom operates. 

MORRIS'S MATERIA MEDICA AND THERAPEUTICS. Fifth 
Edition, Revised. 
Essentials of Materia Medica, Therapeutics, and Prescription= 
Writing. By Henry Morris, M.D., late Demonstrator of Thera- 
peutics, Jefferson Medical College, Philadelphia; Fellow of the College 
of Physicians, Philadelphia, etc. Crown octavo, 288 pages. Cloth, 
;^i.oo; interleaved for notes, $1.25. 

[See Saunders' Question- Compe?ids, page 21.] 

*' This work, already excellent in the old edition, has been largely improved by revi 
sion. " — American Practitioner and News. 

MORRIS, WOLFF, AND POWELL'S PRACTICE OF MEDICINE. 
Third Edition, Revised. 
Essentials of the Practice of Medicine. By Henry Morris, M.D., 
late Demonstrator of Therapeutics, Jefferson Medical College, Phila- 
delphia ; with an Appendix on the Clinical and Microscopic Examina- 
tion of Urine, by Lawrence Wolff, M.D. , Demonstrator of Chemistry, 
Jefferson Medical College, Philadelphia. Enlarged by some 300 essen- 
tial formulae collected and arranged by William M. Powell, M.D. 
Post-octavo, 488 pages. Cloth, $2.00. 

[See Saunders' Question- Compends, page 21.] 

" The teaching is sound, the presentation graphic ; matter full as can be desired, and 
style attractive." — American Practitioner and News. 
2 



18 Medical Publications of W. B, Saunders. 

MORTEN'S NURSE'S DICTIONARY. 

Nurse's Dictionary of Medical Terms and Nursing Treat- 
ment. Containing Definitions of the Principal Medical and Nursing 
Terms and Abbreviations ; of the Instruments, Drugs, Diseases, Acci- 
dents, Treatments, Operations, Foods, Appliances, etc. encountered 
in the ward or in the sick-room. By Honnor Morten, author of 
" How to Become a Nurse," etc. i6mo, 140 pages. Cloth, ^i.oo. 

'* A handy, compact little volume, containing a large amount of general information, all 
of which is arranged in dictionary or encyclopedic form, thus facilitating quick reference. 
It is certainly of value to those for whose use it is published." — Chicago Clinical' Review. 

NANCREDE'S ANATOMY. Fifth Edition. 

Essentials of Anatomy, including the Anatomy of the Viscera. 
By Charles B. Nancrede, M.D., Professor of Surgery and of Clini- 
cal Surgery in the University of Michigan, Ann Arbor. Crown octavo, 
388 pages; 180 illustrations. With an Appendix containing over 60 
illustrations of the osteology of the human body. Based upon Graf s 
Anatomy. Cloth, ^i. 00; interleaved for notes, ;^ 1.25. 
[See Saunders' Question- Co7npends, page 21.] 

" For self-quizzing and keeping fresh in mind the knowledge of anatomy gained at 
school, it would not be easy to speak of it in terms too favorable." — American Practitioner. 

NANCREDE'S ANATOMY AND DISSECTION. Fourth Edition. 
Essentials of Anatomy and Manual of Practical Dissection. 

By Charles B. Nancrede, M.D. , Professor of Surgery and of Clinical 
Surgery, University of Michigan, Ann Arbor. Post-octavo ; 500 pages,, 
with full-page lithographic plates in colors, and nearly 200 illustrations. 
Extra Cloth (or Oilcloth for the dissection-room), ^2.00 net. 

" It may in many respects be considered an epitome of Gray's popular work on general 
anatomy, at the same time having some distinguishing characteristics of its own to commend 
it. The plates are of more than ordinary excellence, and are of especial value to students 
in their work in the dissecting room." — Journal of the American Medical Association. 

NORRIS'S SYLLABUS OF OBSTETRICS. Third Edition, Revised. 
Syllabus of Obstetrical Lectures in the Medical Department 
of the University of Pennsylvania. By Richard C. Norris, 
A.M., M.D., Demonstrator of Obstetrics, University of Pennsylvania. 
Crown octavo, 222 pages. Cloth, interleaved for notes, ^2.00 net. 

"This work is so far superior to others on the same subject that we take pleasure in 
calling attention briefly to its excellent features. It covers the subject thoroughly, and will 
prove invaluable both to the student and the practitioner. ' ' — Medical Record, New York. 

PENROSE'S DISEASES OF WOMEN. Second Edition, Revised. 
A Text=Book of Diseases of Women. By Charles B. Penrose, 
M.D., Ph.D., Professor of Gynecology in the University of Pennsyl- 
vania; Surgeon to the Gynecean Hospital, Philadelphia. Octavo 
volume of 529 pages, handsomely illustrated. Cloth, $3.50 net. 

"I shall value very highly the copy of Penrose's 'Diseases of Women' received. 
I have already recommended it to my class as THE BEST book."— Howard A. Kelly^ 
Professor of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Md. 

" The book is to be commended without reserve, not only to the student but to the 
general practitioner vi^ho wishes to have the latest and best modes of treatment explained 
with absolute clearness." — Therapeutic Gazette. 



Medical Publications of W, B, Saunders. 19 

POWELL'S DISEASES OF CHILDREN. Second Edition. 

Essentials of Diseases of Children. By William M. Powell, 
M.D., Attending Physician to the Mercer House for Invalid Women 
at Atlantic City, N. J. ; late Physician to the Clinic for the Diseases of 
Children in the Hospital of the University of Pennsylvania. Crown 
octavo, 222 pages. Cloth, $i.oo; interleaved for notes, $1.25. 

[See Saunders^ Question- Compends, page 21.] 

"Contains the gist of all the best works in the department to which it relates."— 
American Practitioner and News. 

PRINQLE'S SKIN DISEASES AND SYPHILITIC AFFECTIONS. 
Pictorial Atlas of Skin Diseases and Syphilitic Affections 
(American Edition). Translation from the French. Edited by 
J. J. Pringle, M.B., F.R.C.P., Assistant Physician to the Middlesex 
Hospital, London. Photo-lithochromes from the famous models in 
the Museum of the Saint-Louis Hospital, Paris, with explanatory wood- 
cuts and text. In 12 Parts. Price per Part, $3.00. Complete in 
one volume. Half Morocco binding, ^40.00 net. 

"I strongly recommend this Atlas. The plates are exceedingly well executed, and 
will be of great value to all studying dermatology." — STEPHEN Mackenzie, M.D. 

' ' The introduction of explanatory wood-cuts in the text is a novel and most important 
feature which greatly furthers the easier understanding of the excellent plates, than which 
nothing, we venture to say, has been seen better in point of correctness, beauty, and general 
merit." — New York Medical Journal. 

PYE'S BANDAGING. 

Elementary Bandaging and Surgical Dressing. With Direc- 
tions concerning the Immediate Treatment of Cases of Emergency. 
For the use of Dressers and Nurses. By Walter Pye, F.R.C.S., late 
Surgeon to St. Mary's Hospital, London. Small i2mo, with over 80 
illustrations. Cloth, flexible covers, 75 cents net. 

" The directions are clear and the illustrations are good." — London Lancet. 
" The author writes well, the diagrams are clear, and the book itself is small and port- 
able, although the paper and type are good." — British Medical Journal. 

RAYMOND'S PHYSIOLOGY. 

A Manual of Physiology. By Joseph H. Raymond, A.M., M.D., 
Professor of Physiology and Hygiene and Lecturer on Gynecology in 
the Long Island College Hospital; Director of Physiology in the 
Hoagland Laboratory, etc. 382 pages, with 102 illustrations in the 
text, and 4 full-page colored plates. Cloth, ^1.25 net. 

" Extremely well gotten up, and the illustrations have been selected with care. The 
text is fully abreast with modern physiology." — British Medical Journal. 

RONTGEN RAYS. 

Archives of the Rontgen Ray (Formerly Archives of Clinical 
Skiagraphy). Edited by Sydney Rowland, M.A., M.R.C.S., and 
W. S. Hedley, M.D., M.R.C.S. A series of collotype illustrations, 
with descriptive text; illustrating the applications of the new photo- 
graphy to Medicine and Surgery. Price per Part, ;^i.oo. Now ready: 
Vol. L, Parts L to IV.; Vol. IL, Parts L, H. 




C A J ,, ,p^pp ^^ Arranged in Question and 

^^ Answer Form^ 

V^ UHO i l^iN q-THE MOST COMPLETE AND BEST' 

(^Ol^TTPTHNT'nC ILLUSTRATED SERIES OF 

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OVER 165,000 COPIES SOLD. 



-^s-» 



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They are the advance guard of "Student's Helps" — that DO help. They are the 
leaders in their special line, well and authoritatively written by able men, who, as teachers in 
the large colleges, know exactly what is wanted by a student preparing for his examinations. 
The judgment exercised in the selection of authors is fully demonstrated by their professional 
standing. Chosen from the ranks of Demonstrators, Quiz-masters, and Assistants, most of 
them have become Professors and Lecturers in their respective colleges. 

Each book is of convenient size (5x7 inches) , containing on an average 250 pages, 
profusely illustrated, and elegantly printed in clear, readable type, on fine paper. 

The entire series, numbering twenty-three volumes, has been kept thoroughly revised 
and enlarged when necessary, many of the books being in their fifth and sixth editions. 

TO SUM UP. 

Although there are numerous other Quizzes, Manuals, Aids, etc. in the market, none of 
them approach the "Blue Series of Question Compends ;" and the claim is made for the 
following points of excellence : 

1. Professional distinction and reputation of authors. 

2. Conciseness, clearness, and soundness of treatment. 

3. Quality of illustrations, paper, printing, and binding. 

Any cf these Compends will be mailed on receipt of price (see next page for List). 



Oaunders^ Question-Compend Series. 

Price, Cloth, $1.00 per copy, except when otherwise noted. 



"Where the work of preparing students' manuals is to end we cannot say, but the 
Saunders Series, in our opinion, bears off the palm at prfisent."—JVezu York Medical Record. 



1. ESSENTIALS OF PHYSIOLOGY. By H. A. Hare, M.D. Third edition, 

revised and enlarged. ($i.oo net.) 

2. ESSENTIALS OF SURGERY. By Edward Martin, M.D. Sixth edition, 

revised, with an Appendix on Antiseptic Surgery. 

3. ESSENTIALS OF ANATOMY. By Charles B. Nancrede, M.D. Fifth 

edition, with an Appendix. 

4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC. 

By Lawrence Wolff, M.D. Fourth edition, revised, with an Appendix. 

5. ESSENTIALS OF OBSTETRICS. By W. Easterly Ashton, M.D. Fourth 

edition, revised and enlarged. 

6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. By C. E. 

Armand Setmple, M.D. 

7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRE- 

SCRIPTION=WRITING. By Henry Morris, M.D. Fifth edition, revised. 

8. 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, 

M.D. An Appendix on Urine Examination. By Lawrence Wolff, M.D. 
Third edition, enlarged by some 300 Essential FormulcS, selected from eminent 
authorities, by Wm. M. Powell, M.D, (Double number, $2.00.) 

10. ESSENTIALS OF GYNECOLOGY. By Edwin B. Cragin, M.D. Fourth 

edition, revised. 

11. ESSENTIALS OF DISEASES OF THE SKIN. By Henry W. Stelwagon, 

M.D. Third edition, revised and enlarged. ($1.00 net.) 

12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL 

DISEASES. By Edward Martin, M.D. Second ed., revised and enlarged. 

13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. 

By C. E. Armand Semple, M.D. 

14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. 

By Edward Jackson, ]\LD., and E. B. Gleason, M.D. Second ed., revised. 

15. ESSENTIALS OF DISEASES OF CHILDREN. By William M. Powell, 

]NLD. Second edition. 

16. ESSENTIALS OF EXAMINATION OF URINE. By Lawrence Wolff, 

]\LD, Colored "VoGEL Scale." (75 cents.) 

1 7. ESSENTIALS OF DIAGNOSIS. By S. Solis Cohen, M.D., and A. A. Eshner, 

M.D. ($1.50 net.) 

18. ESSENTIALS OF PRACTICE OF PHARMACY. By Lucius E. Sayre. 

Second edition, revised and enlarged. 

20. ESSENTIALS OF BACTERIOLOGY. By M. V. Ball, M.D. Third edition, 

revised. 

21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. By John C. 

Shaw, M.D. Third edition, revised. 

22. ESSENTIALS OF MEDICAL PHYSICS. By Fred J. Brockway, M.D. 

Second edition, revised. ($1.00 net.) 

23. ESSENTIALS OF MEDICAL ELECTRICITY. By David D. Stewart, M.D., 

and Edward S. Lawrance, M.D. 

24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Gleason, M.D. 

Second edition, revised and greatly enlarged. 



Pamphlet containing specimen pages, etc. sent free upon application. 




Saunders' , ^ , 

tor otudents 

New Series and 

of Manuals Practitioners. 



•* I 'HAT there exists a need for thoroughly reliable hand-books on the leading branches 
of Medicine and Surgery is a fact amply demonstrated by the favor with which 
the SAUNDERS NEW SERIES OF MANUALS have been received by medical 
students and practitioners and by the Medical Press, These manuals are not merely 
condensations from present literature, but are ably w^ritten by well-known authors 
and practitioners, most of them being teachers in representative American colleges* 
Each volume is concisely and authoritatively written and exhaustive in detail, without 
being encumbered with the introduction of ^^cases,'^ which so largely expand the 
ordinary text-book. These manuals will therefore form an admirable collection of 
advanced lectures, useful alike to the medical student and the practitioner: to the 
latter, too busy to search through page after page of elaborate treatises for wfiat he 
wants to know, they will prove of inestimable value ; to the former they will afford 
safe guides to the essential points of study. 

The SAUNDERS NEW SERIES OF MANUALS are conceded to be superior 
to any similar books now on the market. No other manuals afford so much infor- 
mation in such a concise and available form. A liberal expenditure has enabled the 
publisher to render the mechanical portion of the work worthy of the high literary 
standard attained by these books. 

Any of these Manuals will be mailed on receipt of price (see next page for List). 



Saunders^ New Series of Manuals* 



VOLUMES PUBLISHED. 

PHYSIOLOGY. By Joseph Howard Raymond, A.M., M.D., Professor of Physiology 
and Hygiene and Lecturer on Gynecology in the Long Island College Hospital ; 
Director of Physiology in the Hoagland Laboratory, etc. Illustrated. Cloth, $1.25 net. 

SURGERY, General and Operative. By John Chalmers DaCosta, M.D., Clini- 
cal Professor of Surgery, Jefferson Medical College, Philadelphia; Surgeon to the 
Philadelphia Hospital, etc. Second edition, thoroughly revised and greatly enlarged. 
Octavo, 900 pages, profusely illustrated. Cloth, $4. 00 net ; Half Morocco, ^5.00 net. 

DOSE=BOOK AND MANUAL OF PRESCRIPTION=WRITING. By E. Q. 

Thornton, M.D., Demonstrator of Therapeutics, Jefferson Medical College, Phila- 
delphia. Illustrated. Cloth, $1.25 net. 

SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark's Hospital and 
to the New York German Poliklinik, etc. Illustrated. Cloth, $1.25 net. 

MEDICAL JURISPRUDENCE. By Henry C. Chapman, M.D. Professor of Insti- 
tutes of Medicine and Medical Jurisprudence in the Jefferson Medical College of Phila- 
delphia. Illustrated. Cloth, ^1.50 net. 

SYPHILIS AND THE VENEREAL DISEASES. By James Nevins Hyde, M.D., 
Professor of Skin and Venereal Diseases, and Frank H. Montgomery, M.D., 
Lecturer on Dermatology and Genito-Urinary Diseases in Rush Medical College, 
Chicago. Profusely illustrated. (Double number.) Cloth, $2.50 net. 

PRACTICE OF MEDICINE. By George Roe Lockwood, M.D., Professor of 
Practice in the Woman's Medical College of the New York Infirmary; Instructor ia 
Physical Diagnosis in the Medical Department of Columbia College, etc. Illustrated. 
(Double number.) Cloth, $2.50 net. 

MANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct Professor of 

Anatomy and Demonstrator of Anatomy, Medical Department of the New York 
University, etc. Beautifully illustrated. (Double Number.) Cloth, $2.50 net. 

MANUAL OF OBSTETRICS. By W. A. Newman Dorland, M.D., Assistant 
Demonstrator of Obstetrics, University of Pennsylvania ; Chief of Gynecological Dis- 
pensary, Pennsylvania Hospital, etc. Profusely illustrated. (Double number.) Cloth, 
^2.50 net. 

DISEASES OF WOMEN. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to 
Middlesex Hospital and Surgeon to Chelsea Hospital, London ; and Arthur E. 
Giles, M.D. , B.Sc. Lond. , F.R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, 
London. Handsomely illustrated. (Double number.) Cloth, $2.^0 net. 



VOLUMES EST PREPARATION. 

NOSE AND THROAT. By D. Braden Kyle, M.D., Clinical Professor of Laryn- 
gology and Rhinology, Jefferson INIedical College, Philadelphia ; Consulting Laryngolo- 
gist, Rhinologist, and Otologist, St. Agnes' Hospital ; Bacteriologist to the Philadel- 
phia Orthopedic Hospital and Infirmary for Nervous Diseases, etc. 

NERVOUS DISEASES. By Charles W. Burr, M.D., Clinical Professor of Nervous 
Diseases, Medico-Chirurgical College. Philadelphia; Pathologist to the Orthopaedic 
Hospital and Infirmary for Nervous Diseases; Visiting Physician to the St. Joseph 
Hospital, etc. 

*** There will be published in the same series, at short intervals, carefully-prepared works 
on various subjects by prominent specialists. 



Pamphlet containing specimen pages, etc. sent free upon application* 



24 Medical Publications of W. B. Saunders. 

SAUNDBY'S RENAL AND URINARY DISEASES. 

Lectures on Renal and Urinary Diseases. By Robert Saundbv, 
M.D. Edin., Fellow of the Royal College of Physicians, London, and 
of the Royal Medico-Chirurgical Society ; Physician to the General 
Hospital ; Consulting Physician to the Eye Hospital and to the Hos- 
pital for Diseases of Women; Professor of Medicine in Mason College, 
Birmingham, etc. Octavo volume of 434 pages, with numerous illus- 
trations and 4 colored plates. Cloth, $2.50 net. 

" The volume makes a favorable impression at once. The style is clear and succinct. 
We cannot find any part of the subject in which the views expressed are not carefully thought 
out and fortified by evidence drawn from the most recent sources. The book may be cordially 
recommended.' ' — British Medical Journal. 

SAUNDERS' POCKET MEDICAL FORMULARY. Fifth Edition, 
Revised. 

By William M. Powell, M.D., Attending Physician to the Mercer 
House for Invalid Women at Atlantic City, N. J. Containing i8oa 
formulae selected from the best-known authorities. With an Appen- 
dix containing Posological Table, Formulae and Doses for Hypo- 
dermic Medication, Poisons and their Antidotes, Diameters of the 
Female Pelvis and Foetal Head, Obstetrical Table, Diet List for Various 
Diseases, Materials and Drugs used in Antiseptic Surgery, Treatment 
of Asphyxia from Drowning, Surgical Remembrancer, Tables of 
Incompatibles, Eruptive Fevers, Weights and Measures, etc. Hand- 
somely bound in flexible morocco, with side index, wallet, and flap. 
^1.75 net. 

" This little book, that can be conveniently carried in the pocket, contains an immense 
amount of material. It is very useful, and, as the name of the author of each prescription 
is given, is unusually reliable." — Medical Record, New York. 

SAUNDERS' POCKET MEDICAL LEXICON. Fourth Edition, 
Revised. 
A Dictionary of Terms and Words used in Medicine and 
Surgery. By John M. Keating, M.D., Fellow of the College of 
Physicians of Philadelphia; Editor of the '^Cyclopaedia of Diseases 
of Children," etc.; Author of the ''New Pronouncing Dictionary of 
Medicine;" and Henry Hamilton, Author of "A New Translation 
of Virgil's ^neid into Enghsh Verse;" Co- Author of the "New 
Pronouncing Dictionary of Medicine." 32mo, 280 pages. Cloth, 
75 cents; Leather. Tucks, ^i.oo. 

"Remarkably accurate in terminology, accentuation, and definition." — Journal of the 
American Medical Association . 

SAYRE'S PHARMACY. Second Edition, Revised. 

Essentials of the Practice of Pharmacy. By Lucius E. Sayre, 
M.D., Professor of Pharmacy and Materia Medica in the University of 
Kansas. Crown octavo, 200 pages. Cloth, ^i.oo; interleaved for 
notes, ^1.25. 

[See Saunders* Question- Compends, page 21.] 

' * The topics are treated in a simple, practical manner, and the work forms a very useful 
student's manual." — Boston Medical and Surgical Journal. 



Medical Publications of W. B, Saunders. 25 

SEMPLE'S LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. 
Essentials of Legal Medicine, Toxicology, and Hygiene. By 

C. E. Armand Semple, B. A. , M. B. Cantab., M. R. C. P. Lond., 
Physician to the Northeastern Hospital for Children, Hackney, etc. 
Crown octavo, 2 1 2 pages ; 130 illustrations. Cloth, $1.00; interleaved 
for notes, $1.25. 

[See Saunders' Question- Co7npends, page 21.] 

" No general practitioner or student can afford to be without this valuable work. The 
subjects are dealt with by a masterly hand." — London Hospital Gazette. 

SEMPLE'S PATHOLOGY AND MORBID ANATOMY. 

Essentials of Pathology and Morbid Anatomy. By C. E. 

Armand Semple, B.A., M.B. Cantab., M.R.C.P. Lond., Physician to 
the Northeastern Hospital for Children, Hackney, etc. Crown octavo, 
174 pages; illustrated. Cloth, $1.00; interleaved for notes, ^ i . 2 5 . 
[See Saunders'' QuestioJi-Compends, page 21.] 

" Should take its place among the standard volumes on the bookshelf of both student 
and practitioner." — London Hospital Gazette. 

SENN'S GENITO=URINARY TUBERCULOSIS. 

Tuberculosis of the Genito=Urinary Organs, Male and Female. 

By Nicholas Senn, M.D., Ph.D., LL.D., Professor of the Practice of 
Surgery and of Clinical Surgery, Rush Medical College, Chicago. 
Handsome octavo volume of 320 pages, illustrated. Cloth, $3.00 net. 

" An important book upon an important subject, and written by a man of mature judg- 
menc and wide experience. The author has given us an instructive book upon one of the 
most important subjects of the day." — Clinical Reporter. 

" A work which adds another to the many obligations the profession owes the talented 
author." — Chicago Medical Recorder. 

SENN'S SYLLABUS OF SURGERY. 

A Syllabus of Lectures on the Practice of Surgery, arranged 
in conformity with " An American Text=Book of Surgery." By 

Nicholas Senn, M.D., Ph.D. , Professor of the Practice of Surgery and 
of Clinical Surgery in Rush Medical College, Chicago. Cloth, ^2.00. 

" This syllabus will be found of service by the teacher as well as the student, the work 
being superbly done. There is no praise too high for it. No surgeon should be without 
it." — Neiv York Medical Times. 

SENN'S TUMORS. 

Pathology and Surgical Treatment of Tumors. By N. Senn, 
M.D., Ph.D., LL.D., Professor of Surgery and of Clinical Surgery, 
Rush Medical College ; Professor of Surgery, Chicago Polyclinic ; 
Attending Surgeon to Presbyterian Hospital ; Surgeon-in-Chief, St. 
Joseph's Hospital, Chicago. Octavo volume of 710 pages, with 515 
engravings, including full-page colored plates. Cloth, $6.00 net; 
Half Morocco, $7.00 net. 

" The most exhaustive of any recent book in English on this subject. It is well illus- 
trated, and will doubtless remain as the principal monograph on the subject in our language 
for some years. The book is handsomely illustrated and printed, and the author has given a 
notable and lasting contribution to surgery." — Journal of the American Medical Association. 



26 Medical Publications of W, B. Saunders. 

SHAW'S NERVOUS DISEASES AND INSANITY. Third EdJtion, 
Revised. 
Essentials of Nervous Diseases and Insanity. By John C. 
Shaw, M.D., Clinical Professor of Diseases of the Mind and Nervous 
System, Long Island College Hospital Medical School ; Consulting 
Neurologist to St. Catherine's Hospital and to the Long Island College 
Hospital. Crown octavo, iS6 pages; 48 original illustrations. Cloth, 
^i.oo ; interleaved for notes, ^1.25. 

[See Saunders' Question- Compends, page 21.] 
" Clearly and intelligently written." — Boston Medical and Surgical Journal. 

"There is a mass of valuable material crowded into this small compass."' — American 
Medico- Surgical Bulletiti. 

STARR'S DIETS FOR INFANTS AND CHILDREN. 

Diets for Infants and Children in Health and in Disease. By 

Louis Starr, M.D., Editor of "An American Text-Book of the 
Diseases of Children." 230 blanks (pocket-book size), perforated 
and neatly bound in flexible morocco. ^1.25 net. 

The first series of blanks are prepared for the first seven months of infant life ; each 
blank indicates the ingredients, but not the quantities, of the food, the latter directions being 
left for the physician. After the seventh month, modifications being, less necessary, the diet 
lists are printed in full. Formulae for the preparation of diluents and foods are appended. 

STELWAQON'S DISEASES OF THE SKIN. Third Edition, Revised. 
Essentials of Diseases of the Skin. By Henry W. Stelwagon, 
M.D., Clinical Professor of Dermatology in the Jefferson Medical 
College, Philadelphia; Dermatologist to the Philadelphia Hospital; 
Physician to the Skin Department of the Howard Hospital, etc. 
Crown octavo, 270 pages; Zd illustrations. Cloth, $1.00 net; inter- 
leaved for notes, ^1.25 net. 

[See Saunders'' Question- Compends, page 21.] 
** The best student's manual on skin diseases we have yet seen." — Times and Register. 

STENGEL'S PATHOLOGY. 

A Manual of Pathology. By Alfred Stengel, M.D., Physician 
to the Philadelphia Hospital; Professor of Clinical Medicine in the 
Woman's Medical College; Physician to the Children's Hospital; 
late Pathologist to the German Hospital, Philadelphia, etc. In 
Freparatio7t. 

STEVENS' MATERIA MEDICA AND THERAPEUTICS. Second 
Edition, Revised. 
A Manual of Materia Medica and Therapeutics. By A. A. 

Stevens, A.M., M.D., Lecturer on Terminology and Instructor in 
Physical Diagnosis in the University of Pennsylvania; Demonstrator 
of Pathology in the Woman's Medical College of Philadelphia. Post- 
octavo, 445 pages. Cloth, ^2.25. 

"The author has faithfully presented modern therapeutics in a comprehensive work, 
and, while intended particularly for the use of students, it will be found a reliable guide and 
sufficiently comprehensive for the physician in practice." — University Medical Magazine. 



Medical Publications of W. B. Saunders, 27 

STEVENS' PRACTICE OF MEDICINE. Fifth Edition, Revised. 
A Manual of the Practice of Medicine. By A. A. Stevens, A.M., 
M.D., Lecturer on Terminology and Instructor in Physical Diagnosis 
in the University of Pennsylvania ; Demonstrator of Pathology in 
the Woman's Medical College of Philadelphia. Specially intended 
for students preparing for graduation and hospital examinations. Post- 
octavo, 511 pages; illustrated. Flexible leather, $2.50. 

" The frequency with which new editions of this manual are demanded bespeaks its 
popularity. It is an excellent condensation of the essentials of medical practice for the 
student, and may be found also an excellent reminder for the busy physician." — Buffalo 
Aledical Jotirnal. 

STEWART'S PHYSIOLOGY. 

A Manual of Physiology, with Practical Exercises. For 
Students and Practitioners. By G. N. Stewart, M.A., M.D., 
D.Sc, lately Examiner in Physiology, University of Aberdeen, and 
of the New Museums, Cambridge University ; Professor of Physiology 
in the Western Reserve University, Cleveland, Ohio. Octavo volume 
of 800 pages; 278 illustrations in the text, and 5 colored plates. 
Cloth, ^3.50 net. 

" It will make its way by sheer force of merit, and amply deserves to do so. It is one 
of the very best English text-books on the subject." — London Lancet. 

' ' Of the many text-books of physiology published, we do not know of one that so 
nearly comes up to the ideal as does Prof. Stewart's volume." — British Medical Jotirnal. 

STEWART AND LAWRANCE'S MEDICAL ELECTRICITY. 

Essentials of Medical Electricity. By D. D. Stewart, M.D., 
Demonstrator of Diseases of the Nervous System and Chief of the 
Neurological Clinic in the Jefferson Medical College; and E. S. 
Lawrance, M.D., Chief of the Electrical Clinic and Assistant Demon- 
strator of Diseases of the Nervous System in the Jefferson Medical 
College, etc. Crown octavo, 158 pages; 65 illustrations. Cloth, 
^ 1 . 00 ; interleaved for notes, ^1.25. 

[See Saunders' Question- Compe?ids, page 21.] 

" Throughout the whole brief space at their command the authors show a discriminating 
knowledge of their subject." — Medical News. 

STONEY'S NURSING. Second Edition, Revised. 

Practical Points in Nursing. For Nurses in Private Practice. 

By Emily A. M. Stoney, Graduate of the Training-School for Nurses, 
Lawrence, Mass. ; late Superintendent of the Training-School for 
Nurses, Carney Hospital, South Boston, Mass. 456 pages, illustrated 
with 73 engravings in the text, and 8 colored and half-tone plates. 
Cloth, $1.75 net. 

" There are few books intended for non-professional readers which can be so cordially 
endorsed by a medical journal as can this one." — Therapeutic Gazette. 

" This is a well-written, eminently practical volume, which covers the entire range of 
private nursing as distinguished from hospital nursing, and instructs the nurse how best to 
meet the various emergencies which may arise, and how to prepare everything ordinarily 
needed in the illness of her patient." — American Jourtial of Obstetrics and Diseases of 
Women and Children. 

" It is a work that the physician can place in the hands of his private nurses with the 
assurance of benefit." — Ohio Medical Journal. 



28 Medical Publications of W. B. Saunders. 

SUTTON AND GILES' DISEASES OF WOMEN. 

Diseases of Women. By J. Bland Sutton, F.R.C.S., Assistant 
Surgeon to Middlesex Hospital, and Surgeon to Chelsea Hospital, 
London; and Arthur E. Giles, M.D., B.Sc. Lond., F.R.C.S. Edin., 
■ Assistant Surgeon to Chelsea Hospital, London. 436 pages, hand- 
somely illustrated. Cloth, ^2.50 net. 

"The book is very well prepared, and is certain to be well received by the medical 
public." — British Medical Journal . 

"The text has been carefully prepared. Nothing essential has been omitted, and its 
teachings are those recommended by the leading authorities of the day. ' ' — Jouj-nal of thi 
American Medical Association. 

THOMAS'S DIET LISTS AND SICK=ROOM DIETARY. 

Diet Lists and Sick=Room Dietary. By Jerome B. Thomas, 
M.D., Visiting Physician to the Home for Friendless Women and 
Children and to the Newsboys' Home ; Assistant Visiting Physician 
to the Kings County Hospital. Cloth, ^1.50. Send for sample sheet. 
" The idea is good, and the lists are copious." — London Lancet. 

"Its practical usefulness places it among the requirements of every practitioner."—^ 
Chicago Medical Recorder. 

THORNTON'S DOSE=BOOK AND PRESCRIPTION=WRITING. 

Dose=Book and Manual of Prescription=Writing. By E. Q. 

Thornton, M.D., Demonstrator of Therapeutics, Jefferson Medical 
College, Philadelphia. 334 pages, illustrated. Cloth, $1.25 net. 

"Full of practical suggestions; will take its place in the front rank of works of this 
sort." — Medical Record, New York. 

VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH. 
Diseases of the Stomach. By William W. Van Valzah, M.D., 
Professor of General Medicine and Diseases of the Digestive System 
and the Blood, New York Polyclinic; and J. Douglas Nisbet, M.D., 
Adjunct Professor of General Medicine and Diseases of the Digestive 
System and the Blood, New York Polyclinic. Octavo volume of 674 
pages, illustrated. Cloth, $3.50 net. 

VIERORDT'S MEDICAL DIAGNOSIS. Fourth Edition, Revised. 
Medical Diagnosis. By Dr. Oswald Vierordt, Professor of Medi- 
cine at the University of Heidelberg. Translated, with additions, 
from the fifth enlarged German edition, with the author's permission, 
by Francis H. Stuart, A. M., M. D. Handsome royal octavo volume 
of 600 pages; 194 fine wood-cuts in text, many of them in colors. 
Cloth, ^4.00 net; Sheep or Half Morocco, $5.00 net; Half Russia, 
$5.50 net. 

" A treasury of practical information which will be found of d?ily use to every busy 
practitioner who will consult it."— C. A. Lindsley, M.D., Professor of the Theory and 
Practice of Medicine, Yale University. 

" Rarely is a book published with which a reviewer can find so little fault as with the 
volume before us. Each particular item in the consideration of an organ or apparatus, which 
is necessary to determine a diagnosis of any disease of that organ, is mentioned ; nothing 
seems forgotten. The chapters on diseases of the circulatory and digestive apparatus and 
nervous system are especially full and valuable. The reviewer would repeat that the book is 
one of the best— probably the dest— which has fallen into his hands." — University Medical 
Magazme. 



Medical Publications of W. B. Saunders. 29 

WARREN'S SURGICAL PATHOLOGY AND THERAPEUTICS. 

Surgical Pathology and Therapeutics. By John Collins Warren, 
M.D., LL.D., Professor of Surgery, Medical Department Harvard 
University; Surgeon to the Massachusetts General Hospital, etc. 
Handsome octavo volume of 832 pages; 136 relief and lithographic 
illustrations, 33 of which are printed in colors, and all of which were 
drawn by William J. Kaula from original specimens. Cloth, ^6.00 
net; Half Morocco, ^7.00 net. 

''There is the work of Dr. Warren, which I think is the most creditable book on 
Surgical Pathology, and the most beautiful medical illustration of the bookmaker's art, that 
has ever been issued from the American press." — Dr. Roswell Park, in the Harvard 
Graduate Magazine. 

" The handsomest specimen of bookmaking that has ever been issued from the American 
medical press." — American Journal of the Medical Sciences. 

" A most striking and very excellent feature of this book is its illustrations. Without 
exception, from the point of accuracy and artistic merit, they are the best ever seen in a work 
of this kind. Many of those representing microscopic pictures are so perfect in their coloring 
and detail as almost to give the beholder the impression that he is looking down the barrel 
of a microscope at a well-mounted section." — Aiinals of Surgery, 

WEST'S NURSING. 

An American Text=Book of Nursing. By American Teachers. 
Edited by Roberta M. West, late Superintendent of Nurses in the 
Hospital of the University of Pennsylvania. In Preparatio7i. 

WOLFF ON EXAMINATION OF URINE. 

Essentials of Examination of Urine. By Lawrence Wolff, M.D., 
Demonstrator of Chemistry, Jefferson Medical College, Philadelphia, 
etc. Colored (Vogel) urine scale and numerous illustrations. Crown 
octavo. Cloth, 75 cents. 

[See Saunde7's' Question- Coinpends., P3.ge 21.] 
** A very good work of its kind — very well suited to its purpose." — Times and Register. 

WOLFF'S MEDICAL CHEMISTRY. Fourth Edition, Revised. 

Essentials of Medical Chemistry, Organic and Inorganic. 

Containing also Questions on Medical Physics, Chemical Physiology, 
Analytical Processes, Urinalysis, and Toxicology. By Lawrence 
Wolff, M.D., Demonstrator of Chemistry, Jefferson Medical College, 
Philadelphia, etc. Crown octavo, 218 pages. Cloth, ^i. 00; inter- 
leaved for notes, ^1.25. 

[See Saunders' Question- Compends, page 21.] 

"The scope of this work is certainly equal to that of the best course of lectures on 
Medical Chemistry." — Pharmaceutical Era. 



CLASSIFIED LIST 



Medical Publications 



W^ B. SAUNDERS, 

925 Walnut Street, Philadelphia. 



ANATOMY, EMBRYOLOGY, 
HISTOLOGY. 

Clarkson — A Text-Book of Histology, 9 
Haynes — A Manual of Anatomy, . . . 13 
Heisler — A Text- Book of Embryology, 13 
Nancrede — Essentials of Anatomy, . . 18 
Nancrede — Essentials of Anatomy and 

Manual of Practical Dissection, ... 18 
Semple — Essentials of Pathology and 

Morbid Anatomy, 25 

BACTERIOLOGY. 

Ball — Essentials of Bacteriology, ... 6 
Crookshank — A Text- Book of Bacteri- 
ology, 10 

Frothingham — Laboratory Guide, . . ii 
Mallory and Wright — Pathological 

Technique, 16 

McFarland — Pathogenic Bacteria, . . 17 

CHARTS, DIET-LISTS, ETC. 

Griffith — Infant's Weight Chart, ... 12 
Hart — Diet in Sickness and in Health, . 13 

Keen — Operation Blank, 15 

Laine — Temperature Chart, ... -15 
Meigs — Feeding in Early Infancy, . . 17 
Starr — Diets for Infants and Children, . 26 
Thomas — Diet-Lists and Sick-Room 
Dietary 28 

CHEMISTRY AND PHYSICS. 

Brockway — Essentials of Medical Phys- 
ics, .... 7 

Wolff — Essentials of Medical Chemistry, 29 

CHILDREN. 

An American Text-Book of Diseases 

of Children, . . 3 

Griffith— Care of the Baby 12 

Griffith — Infant's Weight Chart, ... 12 

Meigs — Feeding in Early Infancy, . . 17 

Powell — Essentials of Dis. of Children, 19 

Starr — Diets for Infants and Children, . 26 

DIAGNOSIS. 

Cohen and Eshner — Essentials of Di- 
agnosis, 9 

Corwin — Physical Diagnosis, .... 9 

Macdonald — Surgical Diagnosis and 
Treatment, 16 

Vierordt — Medical Diagnosis, .... 28 

DICTIONARIES. 

Keating — Pronouncing Dictionary, . . 14 

Morten — Nurse's Dictionary, .... 18 

Saunders' Pocket Medical Lexicon, . 24 



EYE, EAR, NOSE, AND THROAT. 

An American Text- Book of Diseases 

of the Eye, Ear, Nose, and Throat, . 3 
Casselberry — Dis. of Nose and Throat, S 
De Schweinitz — Diseases of the Eye, . 10 
Gleason — Essentials of Dis. of the Ear, 11 
Jackson and Gleason — Essentials of 

Diseases of the Eye, Nose, and Throat, 14 
Kyle — Diseases of the Nose and Throat. 15 

GEN1T0=URINARY. 

An American Text-Book of Genito- 
urinary and Skin Diseases, 4 

Hyde and Montgomery — Syphilis and 
the Venereal Diseases, 13 

Martin — Essentials of Minor Surgery. 
Bandaging, and Venereal Diseases, . 16 

Saundby — Renal and Urinary Diseases, 24 

Senn — Genito-Urinary Tuberculosis, . 25 

GYNECOLOGY. 

American Text-Book of Gynecology, 4 

Cragin — Essentials of Gynecology, . . 10 

Garrigues — Diseases of W^omen, ... 11 

Long — Syllabus of Gynecology, ... 15 

Penrose — Diseases of Women, .... 18^ 

Sutton and Giles — Diseases of Women, 28 

MATERIA MEDICA, PHARMACOL* 
OGY, AND THERAPEUTICS. 

An American Text-Book of Apphed 

Therapeutics, 3. 

Butler — Text-Book of Materia Medica, 

Therapeutics and Pharmacology, ... 8- 
Cerna — Notes on the Newer Remedies, 8 
Griffin — Materia Med and Therapeutics, 12 
Morris — Essentials of Materia Medica 

and Therapeutics, . . 17 

Saunders' Pocket Medical Formulary, 24 
Sayre — Essentials of Pharmacy, ... 24 
Stevens — Essentials of Materia Medica 

and Therapeutics, 26 

Thornton — Dose-Book and Manual of 

Prescription-Writing 28 

Warren — Surgical Pathology and Ther- 
apeutics, 29- 

MEDICAL JURISPRUDENCE AND 
TOXICOLOGY. 

An American Text-Book of Legal 
Medicine and Toxicology, 4 

Chapman — Medical Jurisprudence and 
Toxicology, 8- 

Semple — Essentials of Legal Medicine. 
Toxicology, and Hygiene, 25, 



Medical Publications of W. B, Saunders. 



31 



NERVOUS AND MENTAL 
DISEASES, ETC. 

Burr — Nervous Diseases, 7 

Chapin — Compendium of Insanity, . . 8 
Church and Peterson — Nervous and 

Mental Diseases, 9 

Shaw — Essentials of Nervous Diseases 

and Insanity, 26 

NURSING. 

An American Text-Book of Nursing, 29 

Griffith— The Care of the Baby, ... 12 

Hampton — Nursing, 12 

Hart — Diet in Sickness and in Health, 13 

Meigs — Feeding in Early Infancy, . . 17 

Morten — Nurses Dictionary 18 

Stoney — Practical Points in Nursing, . 27 

OBSTETRICS. 

An American Text-Book of Obstetrics, 4 
Ashton — Essentials of Obstetrics, . . 6 
Boisliniere— Obstetric Accidents, Emer- 
gencies, and Operations, 7 

Dorland — Manual of Obstetrics, . . . lo 

Hirst — Text-Book of Obstetrics, ... 13 

Norris — Syllabus of Obstetrics, .... 18 

PATHOLOGY. 

An American Text-Book of Pathology, 5 
Mallory and Wright — Pathological 

Technique, 16 

Semple — Essentials of Pathology and 

Morbid Anatomy, 25 

Senn — Pathology and Surgical Treat- 
ment of Tumors, 25 

Stengel — Manual of Pathology, . . 26 
Warren — Surgical Pathology and Thera- 
peutics, 29 

PHYSIOLOGY. 

An American Text-Book of Physi- 
ology, 5 

Hare — Essentials of Physiology, ... 13 
Raymond — Manual of Physiology, . . I9 
Stewart — Manual of Physiology, ... 27 

PRACTICE OF MEDICINE. 

An American Text-Book of the The- 
ory and Practice of Medicine, .... 5 

An American Year-Book of Medicine 
and Surgery, ... . . 6 

Anders — Text-Book of the Practice of 
Medicine, 6 

Lockwood — Manual of the Practice of 
Medicine, . . .... 15 

Morris — Essentials of the Practice of 
Medicine, . . ....... 17 

Rowland and Hedley — Archives of 
the Roentgen Ray, 19 

Stevens — Manual of the Practice of 
Medicine, 27 

SKIN AND VENEREAL. 

An American Text-Book of Genito- 
urinary and Skin Diseases, 3 



Hyde and Montgomery — Syphilis and 
the \'enereal Diseases, 13 

Martin — Essentials of Minor Surgery, 
Bandaging, and Venereal Diseases, . 16 

Pringle — Pictorial Atlas of Skin Dis- 
eases and Syphilitic Affections, ... 19 

Stelwagon — Essentials of Diseases of 
the Skin, 26 

SURGERY. 

An American Text-Book of Surgery, 5 
An American Year-Book of Medicine 

and Surgery 6 

Beck — ISIanual of Surgical Asepsis, . . 7 
DaCosta — Manual of Surgery, . . . . lo 

Keen- Operation Blank 15 

Keen — The Surgical Complications and 

Sequels of Typhoid Fever, 15 

Macdonald — Surgical Diagnosis and 

Treatment, 16 

Martin — Essentials of Minor Surgery, 

Bandaging, and Venereal Diseases, . 16 
Martin — Essentials of Surgery, .... 16 

Moore — Orthopedic Surgery, 17 

Pye — Elementary Bandaging and Surgi- 
cal Dressing, 19 

Rowland and Hedley — Archives of 

the Roentgen Ray, 19 

Senn — Genito-Urinary Tuberculosis, . 25 
Senn- Syllabus of Surgery, . . • • .25 
Senn — Pathology and Surgical Treat- 
ment of Tumors, 25 

Warren — Surgical Pathology and Ther- 
apeutics, 29 

URINE AND URINARY DISEASES. 

Saundby — Renal and Urinary Diseases, 24 
Wolff— Essentials of Examination of 
Urine, 29 



MISCELLANEOUS. 

Bastin — Laboratory Exercises in Bot- 
any, 7 

Gould and Pyle — Anomalies and Curi- 
osities of Medicine, 11 

Keating — How to Examine for Life 
Insurance, I4 

Keen — Surgical Complicat'ons and Se- 
quels of Typhoid Fever, 15 

Rowland and Hedley — Archives of 
the Roentgen Ray, 19 

Saunders' Medical Hand-Atlases, . . 2 

Saunders' New Series of Manuals, 22, 23 

Saunders' Pocket Medical Formulary, 24 

Saunders' Question-Compends, . 20, 21 

Senn — Pathology and Surgical Treat- 
ment of Tumors, ... . .25 

Stewart and Lawrance — Essentials of 
Medical Electricity, 27 

Thornton — Dose-Book and Manual of 
Prescription-Writing, 28 

Van Valzah and Nisbet— Diseases of 
the Stomach, 28 



In Preparation for Early Publication* 



AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, NOSE, 
AND THROAT. 

Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jeffer- 
son Medical College, Philadelphia; and B. ALEXANDER Randall, M.D., Professor 
of Diseases of the Ear in the University of Pennsylvania and in the Philadelphia 
Polyclinic. 

AN AMERICAN TEXT=BOOK OF PATHOLOGY. 

Edited by John Guiteras, M.D., Professor of General Pathology and of Morbid 
Anatomy in the University of Pennsylvania ; and David Riesman, M. D. , Demon- 
strator of Pathological Histology in the University of Pennsylvania. 

AN AMERICAN TEXT=BOOK OF LEGAL MEDICINE AND TOXICOLOGY. 

Edited by FREDERICK Peterson, M.D., Clinical Professor of Mental Diseases in 
the Woman's Medical College, New York; Chief of Clinic, Nervous Department, 
College of Physicians and Surgeons, 'New York ; and Walter S. Haines, M.D., 
Professor of Chemistry, Pharmacy, and Toxicology in Rush Medical College, Chicago, 
Illinois, 

STENGEL'S PATHOLOGY. 

A Manual of Pathology. By Alfred Stengel, M. D., Physician to the 
Philadelphia Hospital ; Professor of Clinical Medicine in the Woman's Medical 
College; Physician to the Children's Hospital; late Pathologist to the German 
Hospital, Philadelphia, etc. 

CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES. 

Nervous and Mental Diseases. By Archibald Church, M.D., Professor of 
Mental Diseases and Medical Jurisprudence in the Northwestern University Medical 
School, Chicago ; and Frederick Peterson, M.D. , Clinical Professor of Mental 
Diseases in the Woman's Medical College, New York ; Chief of Clinic, Nervous 
Department, College of Physicians and Surgeons, New York. 

HEISLER'S EMBRYOLOGY. 

A Text=Book of Embryology. By John C. Heisler, M.D., Professor of 
Anatomy in the Medico-Chirurgical College, Philadelphia. 

KYLE ON THE NOSE AND THROAT. 

Diseases of the Nose and Throat. By D. Braden Kyle, M. D., Clinical Pro- 
fessor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia; Con- 
sulting Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital ; Bacteriologist 
to the Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases, etc. 

HIRST'S OBSTETRICS. 

A Text=Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of 
Obstetrics in the University of Pennsylvania. 

WEST'S NURSING. 

An American Text=Book of Nursing. By American Teachers. Edited by 
Roberta M. West, Late Superintendent of Nurses in the Hospital of the University 
of Pennsylvania. 



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